Objectives
The purposes of this study were to determine the benefit of the bronchiolitis ultrasound score (BUS) in predicting hospital admission in children with acute bronchiolitis and to characterize lung sonography findings.
Methods
This prospective observational study was performed in an academic pediatric emergency department. Children younger than 24 months presenting to the emergency department, diagnosed with acute bronchiolitis by 2 independent pediatricians were included in the study. Lung ultrasound was performed by a single sonographer, who was blinded to as much clinical information as possible. In addition, the treating physicians were blinded to the lung ultrasound findings. Logistic regression analysis models were used to identify admission predictors. Receiver operating characteristic analysis was used to evaluate the predictive value for effects of the BUS and the modified Bronchiolitis Severity Score on admission.
Results
The median age of the 76 patients diagnosed with acute bronchiolitis was 6 months (interquartile range, 3.6–10 months). Forty-two (55.3%) of the 76 patients enrolled were admitted. Lung ultrasound was compatible with acute bronchiolitis in 74 patients (97%). A significant correlation was determined between modified Bronchiolitis Severity Score and BUS in children with acute bronchiolitis (r = 0.698, P < 0.001). The most effective parameter in determining admission on logistic regression analysis, independently of other variables, was BUS (P = 0.044; adjusted odds ratio, 1.859; 95% confidence interval, 1.016–3.404). Bronchiolitis ultrasound score values of 3 or greater exhibited 73.81% sensitivity and 73.53% specificity, whereas BUS values of 4 or greater exhibited 50% sensitivity and 91.18% specificity.
Conclusions
Point-of-care lung ultrasound can accurately detect pulmonary anomalies in children with acute bronchiolitis, has a close correlation with clinical findings, and is a useful tool in predicting hospital admission.
Introduction-A clinical course ranging from mild local findings to life-threatening systemic findings may occur after scorpion stings. The purpose of this study was to identify priority markers indicating scorpion stingÀrelated cardiac involvement.Methods-Our study was performed between July 2014, and September 2015 in theÇukurova University medical faculty pediatric emergency department, in Adana, Turkey. Patients admitted with scorpion stingÀrelated cardiac involvement and a control group consisting of patients with no scorpion stingÀrelated cardiac involvement were included in the study. Troponin I at time of presentation and at 6 and 24 h, N-terminal prohormone of brain natriuretic peptide (NTproBNP), ejection fraction as determined by echocardiography at 24 h, and peak and end of T wave (Tp-e) and Tp-e/QTc ratios with echocardiography at 24 h were evaluated.Results-A patient group consisting of 7 cases of scorpion envenomationÀrelated myocarditis and a control group of 30 cases of scorpion intoxication without myocarditis findings were enrolled. Statistically significantly high glucose, white blood cell values, creatine kinase MB, troponin I, and NTproBNP values were identified in the scorpion stingÀrelated myocarditis group (P<0.05). Ejection fractions determined by echocardiography at time of presentation were significantly lower in the patients with myocarditis compared with the control group (P<0.05). A statistically significant difference was identified between Tp-e/corrected QT interval (QTc) ratios investigated in DI and V2 derivations in patient and control group echocardiograms (P<0.05).Conclusions-We think that use can be made of NTproBNP in addition to echocardiography and troponin I in the early diagnosis of scorpion stingÀrelated myocarditis and that Tp-e and Tp-e/QTc ratios identified via echocardiography can be used as early markers; however, further studies with larger numbers are needed to confirm this.
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