PURPOSE: To review the outcomes of magnet ingestions from two children's hospitals and develop a clinical management pathway.
METHODS: Children <18years old who ingested a magnet were reviewed from 1/2011 to 6/2016 from two tertiary center children's hospitals. Demographics, symptoms, management and outcomes were analyzed.
RESULTS: From 2011 to 2016, there were 89 magnet ingestions (50 from hospital 1 and 39 from hospital 2); 50 (56%) were males. Median age was 7.9 (4.0-12.0) years; 60 (67%) presented with multiple magnets or a magnet and a second metallic co-ingestion. Suspected locations found on imaging were: stomach (53%), small bowel (38%), colon (23%) and esophagus (3%). Only 35 patients (39%) presented with symptoms and the most common symptom was abdominal pain (33%). 42 (47%) patients underwent an intervention, in which 20 (23%) had an abdominal operation. For those undergoing abdominal surgery, an exact logistic regression model identified multiple magnets or a magnet and a second metallic object co-ingestion (OR 12.9; 95% CI, 2.4 - Infinity) and abdominal pain (OR 13.0; 95% CI, 3.2-67.8) as independent risk factors.
CONCLUSION: Magnets have a high risk of requiring surgical intervention for removal. Therefore, we developed a management algorithm for magnet ingestion.
LEVEL OF EVIDENCE: Level III.
We retrospectively studied records of patients who received conservative therapy or surgical operation for ingested foreign body (FB) located below the pylorus, and aimed to analyze the different treatment methods including prevention or operation of foreign bodies (FBs) when we found them in children of different age.The records of 16 patients (11 men and 5 women) who were hospitalized for FB ingestion between 2011 June and 2014 June were evaluated retrospectively. Mean age of the patients was 5.5 years (65.9 ± 61.0 mo). Nine patients underwent operations and 7 patients received conservative therapy. Approximately, 75% of the patients or their families recorded a positive FB swallow history. According to the results of plain radiographs, 81% patients had positive FB findings. Five patients experienced intestinal perforation. The mean duration of hospitalization was 9.13 ± 6.29 days.Intestinal perforation due to FBs is uncommon but needs to be taken into consideration especially when the FB is a magnet. It is not appropriate to give whole nuts to children (age <2 years). Radiographs should be taken 6 to 12 hours apart, and vital signs should be observed when observing a child who has ingested a sharp FB. Lastly, our society should pay more attention to psychotherapeutic needs in prepubertal children.
... independent and paired analyses, after controlling for mode of transportation, emergency department disposition, level of injury severity, and at the NPH trauma center level, hospital type, size, region, and radiology services location AbstractText: NPHs have the potential to substantially reduce the medical radiation received by injured children. PediatricCT protocols should be considered Keyword: CT scan. Keyword: Effective radiation dose.
... needed surgery for a symptomatic CM-II CONCLUSIONS: MMC is not always associated with CM-II. The outcome of CM-II has improved. Post-natal closure can reverse the CM-II. This must be kept in mind when analyzing the result of prenatal series Keyword: Chiari Malformation. Keyword: Post Natal Surgery. Keyword: Reversibility. Keyword: SpinalDysraphism. Keyword: Tonsil Herniatrion Pediatric.
Meningomyelocele (2), Spinal Dysraphism (1), Hydrocephalus (1), more mentions
BACKGROUND: There is a benefit in characterizing radiation-induced cancer risk in pediatric chest and abdominopelvic CT: a singular metric that represents the whole-body radiation burden while also accounting for age, gender and organ sensitivity.
OBJECTIVE: To compute an index of radiation risk for pediatric chest and abdominopelvic CT.
MATERIALS AND METHODS: Using a protocol approved by our institutional review board, 42 pediatric patients (age: 0-16 years, weight: 2-80 kg) were modeled into virtual whole-body anatomical models. Organ doses were estimated for clinical chest and abdominopelvic CT examinations of the patients using validated Monte Carlo simulations of two major scanner models. Using age-, size- and gender-specific organ risk coefficients, the values were converted to normalized effective dose (by dose length product) (denoted as the k factor) and a normalized risk index (denoted as the q factor). An analysis was performed to determine how these factors are correlated with patient age and size for both males and females to provide a strategy to better characterize individualized risk.
RESULTS: The k factor was found to be exponentially correlated with the average patient diameter. For both genders, the q factor also exhibited an exponential relationship with both the average patient diameter and with patient age. For both factors, the differences between the scanner models were less than 8%.
CONCLUSION: The study defines a whole-body radiation risk index for chest and abdominopelvic CT imaging, that incorporates individual estimated organ dose values, organ radiation sensitivity, patient size, exposure age and patient gender. This indexing metrology enables the assessment and potential improvement of chest and abdominopelvic CT performance through surveillance of practice dose profiles across patients and may afford improved informed communication.
The purpose of this study was to formulate a systematic, evidence-based method to relate quantitative diagnostic performance to radiation dose, enabling a multidimensional system to optimize computed tomography imaging across pediatric populations. Based on two prior foundational studies, radiation dose was assessed in terms of organ doses, effective dose ([Formula: see text]), and risk index for 30 patients within nine color-coded pediatric age-size groups as a function of imaging parameters. The cases, supplemented with added noise and simulated lesions, were assessed in terms of nodule detection accuracy in an observer receiving operating characteristic study. The resulting continuous accuracy-dose relationships were used to optimize individual scan parameters. Before optimization, the nine protocols had a similar [Formula: see text] of [Formula: see text] with accuracy decreasing from 0.89 for the youngest patients to 0.67 for the oldest. After optimization, a consistent target accuracy of 0.83 was established for all patient categories with [Formula: see text] ranging from 1 to 10 mSv. Alternatively, isogradient operating points targeted a consistent ratio of accuracy-per-unit-dose across the patient categories. The developed model can be used to optimize individual scan parameters and provide for consistent diagnostic performance across the broad range of body sizes in children.