The low initial SpO and SF ratio, respiratory acidosis, and SF ratio less than 195 at the first hours of treatment were related to unresponsiveness to HFNC therapy in our pediatric emergency department.

Objective:The objective of this study was to evaluate physical examinations, imaging, and laboratory analyses individually and combined using innovative statistical analysis methods for the accurate diagnosis of pediatric appendicitis.Methods: Patients admitted to hospital with symptoms of abdominal pain whose pediatric appendicitis scores greater than 3 were included in the study. Clinical, radiologic, and laboratory findings and as a new biomarker calprotectin (CPT) concentrations were evaluated individually and combined using artificial neural networks (ANNs), which revealed latent relationships for a definitive diagnosis.Results: Three hundred twenty patients were evaluated (190 appendicitis [43 perforated] vs 130 no appendicitis). The mean ± SD age was 11.3 ± 3.6 years and 63% were male. Pediatric appendicitis scores, white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP) level, procalcitonin (PCT) and CPT concentrations were higher in the appendicitis group; however, only WBC and ANC were higher in first 24 hours of pain. White blood cells and CRP were diagnostic markers in patients whose appendix could not be visualized using ultrasonography (US). On classic receiver operating characteristic (ROC) analysis, the areas under the curve (AUCs) were not strong enough for differential diagnosis (WBC, 0.73; ANC, 0.72; CRP, 0.65; PCT and CPT, 0.61). However, when the physical examination, US, and laboratory findings were analyzed in a multivariate model and the ROC analysis obtained from the variables with ANN, an ROC curve could be obtained with 0.91 AUC, 89.8% sensitivity, and 81.2% specificity. C-reactive protein and PCT were diagnostic for perforated appendicitis with 0.83 and 0.75 AUC on ROC.Conclusions: Although none of the biomarkers were sufficient for an accurate diagnosis of appendicitis individually, a combination of physical examination and laboratory and US was a good diagnostic tool for pediatric appendicitis.

Background The aim of this study was to evaluate diaphragmatic parameters in bronchiolitis patients and identify correlations between clinical and sonographic severity scores and outcomes to develop a more objective and useful tool in the emergency department. Methods Children aged between 1 and 24 months and diagnosed with acute bronchiolitis were included in the study. The Modified Respiratory Distress Assessment Instrument (mRDAI) score was used to quantify the clinical severity of the disease. Lung ultrasound was performed and a bronchiolitis ultrasound score (BUS) was calculated. Diaphragm ultrasound was then performed and diaphragm thickness at the end of inspiration and expiration, thickening fraction, diaphragm excursion (EXC), inspiratory slope (IS), expiratory slope (ES), and total duration time of the respiratory cycle were measured. Results There were 104 patients evaluated in this study. The mRDAI score and BUS had a significant positive correlation. There was a positive correlation between IS and respiratory rate at admission. As the clinical score increased, IS, ES, and EXC measurements rose and they were positively correlated. Values of IS, ES, and EXC were higher in the moderate‐severe group than the mild group for both mRDAI and BUS scores. Inspiratory slope values were correlated with the length of stay in the hospital. Conclusion Values of IS and ES were correlated with clinical and sonographic severity scores. Moreover, IS was a good predictor of outcome. Diaphragm ultrasound appears to be an objective and useful tool to help the physician make decisions regarding the evaluation and management of bronchiolitis.

Amacımız üçüncü basamak Çocuk Yoğun Bakım Birimi'mizde trakeostomi sonuçlarını etkileyen klinik özellikleri tanımlamaktır. Gereç ve Yöntemler: Türkiye'de çocuk yoğun bakım birimimizde 2008-2014 yılları arasında trakeostomi uygulanmış çocuk hastaların tıbbi kayıtları geriye dönük olarak incelendi. Bulgular: Toplamda 63 çocuk hasta çalışmaya alındı. Hastaların ortanca yaşı 11 ay (1 ay-195 ay) ve 25 hasta (%39,7) kız idi. Altı yıllık çalışma döneminde trakeostomi oranı %8,5 ve dekanülasyon oranı (n=8) %12,6 bulundu. Kırk dokuz (%77,7) hasta eve taburcu edildi. Trakeostomi uygulama endikasyonları üst hava yolu tıkanıklığı (n=9) ve uzamış mekanik ventilasyon idi (n=54). Trakeostomi öncesi entübasyon süresi ortanca 32 gün (1-122 gün) ve trakeostomi sonrası çocuk yoğun bakım yatış süresi ortanca 37 gündü. Toplamda 21 hasta (% 52,5) mekanik ventilatörden ayrıldı. Üst hava yolu tıkanıklığı nedeniyle trakeostomi uygulanan hastalarda mekanik ventilatörden ayrılma oranı, uzamış mekanik ventilasyon nedeniyle trakeostomi uygulanan hastalardan belirgin yüksekti (p=0,021). Komplikasyon oranı evde %11,1 çocuk yoğun bakımda ise %25,3 saptandı. Çıkarımlar: Trakeostomi uygulaması, çocuk hastaların sonuçlarını iyileştiren güvenli bir yöntem olarak gözükmektedir. Trakeostomi uygulanan çocuklarda seyri etkileyen en önemli etken ise trakeostomi endikasyonu olarak bulunmuştur. Üst hava yolu tıkanıklığı nedeniyle trakeostomi uygulanan hastalarda sonuçların daha iyi olduğu görülmüştür. Çocuk hastalarda uzamış mekanik ventilasyonda trakeostomi uygulaması mekanik ventilatör desteğinin azaltılmasını, mekanik ventilatörden ayrılmayı ve en nihayetinde eve taburculuğu kolaylaştırmaktadır.

Background: Lower respiratory tract infections (LTRIs) are the most common cause of pediatric emergency department visits and are associated with significant morbidity and mortality. The aim of this study was to evaluate the soluble urokinase plasminogen activator receptor (suPAR) levels in pediatric patients with LRTIs and to investigate the correlation of suPAR with disease severity. Methods: This is a prospective case-control study of children with LTRIs. Demographic data, diagnoses, vital signs, disease severity scores, length of hospital stay, laboratory findings, and viral polymerase chain reaction results for nasopharyngeal aspirates were recorded. Blood samples for suPAR were collected and assessed by enzyme-linked immunosorbent assay. Results: There were 94 patients with LTRIs and 32 children in the control group. Patients were further subdivided into 2 groups based on diagnosis of acute bronchiolitis (n: 31, 33%) or pneumonia (n: 63, 67%). The median levels of suPAR were significantly higher in patients with LTRIs than in healthy controls (4.3 and 3.5 ng/mL, respectively; P = 0.003). There was an association between suPAR levels and disease severity in pneumonia patients. suPAR values were higher in patients with severe pneumonia than mild pneumonia (5.5 and 3.6 ng/mL, respectively; P < 0.001). Conclusion:We have shown that suPAR levels increased in patients with LTRIs and suPAR values were higher in patients with severe pneumonia than mild pneumonia. Further studies with large case series are needed to clarify the role of suPAR levels in children with LTRIs.