The Utility of Pediatric Asthma Severity Scores in Disposition Decisions for Status Asthmaticus
Poster May 09, 2018
Ryan KS, McKinley S, Bartlett J, Son S, Wilsey M, Nakagawa TA, Sochet AA
The Pediatric Asthma Severity Score (PASS) is a commonly used clinical and research metric for assessing pediatric asthma exacerbation severity. PASS is not validated for practice beyond distinguishing appropriate initial emergency room (ER) disposition. We aimed to determine if PASS identifies patients with hospital readmission, PICU bounce-back, or late rescue. We performed a retrospective, cohort study from May 2015 to May 2017 in children ≥5 years of age admitted for status asthmaticus. We excluded patients with pulmonary hypertension, chronic lung disease, cystic fibrosis, or tracheostomy. In our facility PASS data were noted prior to all respiratory treatments by trained therapists. Primary outcomes were hospital readmission (<30d of discharge), PICU bounce-back (<24hr readmission after PICU to floor transfer), and late rescue (<24hr PICU transfer after ER to floor admission). PASS data, general outcomes, and cohort characteristics were assessed with Fisher's exact, student's t, and Wilcoxon rank-sum tests. Receiver operator characteristic (ROC) curves yielded area under the curve (AUC) values and PASS cutoffs to discriminate unplanned hospital readmission, PICU bounce-back, and late rescue. Type I error was set at 0.05. Data were analyzed using Stata v13.1.
Of the 227 children who met study criteria, 88 (39%) were PICU admissions and 139 (61%) floor. We noted 2.3% had hospital readmission, 6.5% late rescue, and 5.7% PICU bounce-back. General sample characteristics, asthma classification, comorbidities, applied therapeutics, and routine outcomes did not differ between research cohorts. Discharge PASS did not differ for those w/wo hospital readmission (1 [IQR:1-2] vs 2 [IQR:1-3]). PASS prior to PICU to floor transfer were no different for those w/wo PICU bounce-back (6 [IQR:5-7] vs 4 [IQR:2-5]). PASS just prior to ER to floor admission were greater in those with late rescue (8 [IQR:7-8] vs 6 [IQR:4-8], p=0.03). ROC curve for discharge PASS on hospital readmission yielded an AUC of 0.24. ROC curve for PASS prior to PICU to floor transfer on PICU bounce-back yielded an AUC of 0.74 (95% CI: 0.45-0.99; cutoff PASS 8: 20% SE, 100% SP). ROC curve for PASS prior to ER to floor admission on late rescue yielded an AUC of 0.71 (95% CI: 0.57-0.85; cutoff PASS 8: 78% SE, 62% SP).
PASS may provide insight for acute disposition planning (i.e., selecting an appropriate level of care) rather than determining hospital discharge readiness. Prior to adopting PASS criteria in these scenarios, further study is warranted.
Genome-wide association studies (GWAS) have identified more than 100 genetic loci associated with type 2 diabetes. The majority of these are located in the intergenic or intragenic regions suggesting that the implicated variants may alter chromatin conformation. This, in turn, is likely to influence the expression of nearby or more remotely located genes to alter beta cell function. At present, however, detailed molecular and functional analyses are still lacking for most of these variants. We recently analysed one of these loci and mapped five causal variants in an islet-specific enhancer cluster within the STARD10 gene locus. Here, we aimed to understand how these causal variants influence b-cell function by alteration of the chromatin structure of enhancer clusterREAD MORE
This abstract discusses three cases of pediatric heart transplant patients who suffered from parvovirus (B19) infection. Of these patients, two ( B & C) responded well to standard intravenous Ig therapy. Patient A however, did not respond to standard treatment and was begun on subcutaneous Ig, which effectively diminished his viral load. Thus, subcutaneous Ig infusions might serve as a second line treatment for transplant patients with parvovirus who do not respond well to the standard approach.READ MORE
Angioimmunoblastic T-cell lymphoma (AITL) is a common type of peripheral T-cell lymphoma. AITL can be missed until lymphadenopathy develops in patients initially presenting with skin lesions, as skin biopsy may lack conclusive findings. Our case highlights the extranodal presentation of AITL with cutaneous lesions displaying the TFH phenotype.READ MORE