RESUMO
OBJECTIVES: To characterize the subgroup of outpatient pediatric patients presenting with chest pain and to determine the effectiveness of published pediatric appropriate use criteria (PAUC) to detect pathology. STUDY DESIGN: The Pediatric Appropriate Use of Echocardiography study evaluated the use and yield of transthoracic echocardiography (TTE) before and after PAUC release. Data were reviewed on patients ?18 years of age who underwent TTE for chest pain. Indications were classified as appropriate (A), may be appropriate (M), and rarely appropriate (R) based on PAUC ratings, and findings were normal, incidental, or abnormal. RESULTS: Chest pain was the primary indication in 772 of 4562 outpatient TTE studies (17%) (median age 14 years, IQR 10-16) ordered during the study period: 458 of 772 before (59%) and 314 of 772 after (41 %) the release of PAUC with no change in appropriateness. In A indications (n?=?654), 642 (98%) were normal, 5 (1%) had incidental findings, and 7 (1%) were abnormal. A and M detected 100% of all abnormal findings (A: n?=?7; M: n?=?6; R: n?=?0), with an association between ratings and findings (P?<.001). There was no association between R rating and any pathology. CONCLUSIONS: There was no change in ordering patterns with publication of the PAUC. Despite the high rate of TTEs ordered for indications rated A, most studies were normal. Studies that detected pathology were performed for indications rated A or M, but not R. This study supports PAUC as a useful tool in pediatric chest pain evaluation that may subsequently improve the use of TTE.
Assuntos
Dor no Peito/etiologia , Ecocardiografia/estatística & dados numéricos , Fidelidade a Diretrizes , Guias de Prática Clínica como Assunto , Adolescente , Criança , Estudos Transversais , Cardiopatias Congênitas/diagnóstico , Cardiopatias/diagnóstico , Humanos , Padrões de Prática Médica/estatística & dados numéricos , Estudos Prospectivos , Estados UnidosAssuntos
Humanos , Masculino , Feminino , Cardiopatias Congênitas/diagnóstico , Ecocardiografia/métodos , Ecocardiografia/normas , Pediatria/métodos , Pediatria/normas , Artérias/fisiologia , /métodos , Guias como Assunto/normas , Técnicas e Procedimentos Diagnósticos/normas , Valvas Cardíacas/fisiologia , Veias Pulmonares/fisiologia , Ventrículos do Coração , Volume Sistólico/fisiologiaRESUMO
OBJECTIVE: To evaluate the prevalence and significance of myocardial dysfunction in children with septic shock. STUDY DESIGN: Thirty patients with septic shock were evaluated by transthoracic echocardiography within 24 hours of admission to a pediatric critical care unit. Transthoracic echocardiography evaluation included left ventricular (LV) size and function, mitral valve inflow velocities in early and late diastole, mitral valve annular velocities in systole and early and late diastole, and LV myocardial performance index. LV systolic dysfunction was defined as an ejection fraction or shortening fraction z-score <-2, and LV diastolic dysfunction was defined as a mitral valve inflow velocity/annular velocity in early diastole ratio z-score >2. Secondary outcomes included troponin I concentration, acute kidney injury, and 28-day mechanical ventilation-free duration. RESULTS: Mortality for the 30 patients (mean age, 9.5 ± 7 years) was 7%. The prevalence of LV systolic and/or diastolic dysfunction was 53% (16 of 30). Eleven patients (37%) had systolic dysfunction, 10 (33%) had diastolic dysfunction, and 5 (17%) had both. Systolic and/or diastolic dysfunction was significantly associated with troponin I level (P = .007) and acute kidney injury (P = .02), but not with ventilation-free duration (P = .12). Kaplan-Meier analyses for pediatric critical care unit and hospital length of stay identified no differences between patients with and those without myocardial dysfunction. CONCLUSION: Myocardial dysfunction occurs frequently in children with septic shock but might not affect hospital length of stay.
Assuntos
Contração Miocárdica , Choque Séptico/complicações , Disfunção Ventricular Esquerda/etiologia , Criança , Pré-Escolar , Diástole , Ecocardiografia Doppler , Feminino , Seguimentos , Humanos , Incidência , Lactente , Tempo de Internação/tendências , Masculino , Estudos Prospectivos , Choque Séptico/mortalidade , Taxa de Sobrevida/tendências , Sístole , Estados Unidos/epidemiologia , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
OBJECTIVE: To evaluate the prevalence of coronary artery dilation in children with sickle cell disease (SCD). STUDY DESIGN: This is a retrospective analysis performed in patients, between 10 and 19 years old, with SCD who underwent a routine transthoracic echocardiographic evaluation over a 20-month period. The left main, left anterior descending, and proximal right coronary artery diameters, as well as clinical and laboratory variables and other echocardiographic results were collected. Echocardiographic measurements were converted to z scores by using information from a large control population of normal children. Coronary artery ectasia (CAE) was defined as a coronary artery diameter z score ≥ 2. The patients with CAE were compared with those without CAE by using univariate and multivariate analyses. RESULTS: Seventeen of 96 patients with SCD (17.7%) had CAE. There were no differences in sex, age, height, weight, body surface area, or genotype between those with and those without CAE. Patients with CAE had larger left ventricular end-diastolic dimension, shortening fraction, septal thickness, posterior wall thickness, mass, mass-to-volume ratio, and white blood cell count. Multivariate analysis revealed that the mass-to-volume ratio and elevated white blood cell count were associated with CAE. CONCLUSION: CAE is common in SCD and is associated with left ventricular hypertrophy and inflammation.