Objectives:To construct and validate a model and derive a simple rule that is usable in any birth location for the prediction of outcome of term infants with severe asphyxia. Design:Retrospective cohort study. Setting...Objectives:To construct and validate a model and derive a simple rule that is usable in any birth location for the prediction of outcome of term infants with severe asphyxia. Design:Retrospective cohort study. Setting:Regional outborn neonatal intensive care unit. Participants:Infants with postintrapartum asphyxial hypoxic-ischemic encephalopathy (n = 375). Main Exposures:Clinical and laboratory predictors available at age 4 hours. Main Outcome Measures:A logistic regression model was developed and internally validated (with random sampling and based on the year of birth) for severe adverse outcome,which was defined as death or severe disability (severe cerebral palsy,severe developmental delay,sensorineural deafness,or cortical blindness singly or in com bination). A simple prediction rule was derived from 3 variables. Results:Complete data were available for 302 (92%) of the 345 infants with known outcomes (204 infants with severe adverse outcome). Six independent predictors of outcomes were identified. Using the 3 most significant predictors (chest compressions,age at onset of respiration,and base deficit),severe adverse outcome rates were 46%(95%confidence interval,33%-58%) with none of the 3 predictors,64%(95%confidence interval,54%-73%) with any 1 predictor,76%(95%confidence interval,66%-85%)with any 2 predictors,and 93%(95%confidence interval,81%-99%)-with all of the 3 predictors present. The internal validations revealed a robust model. Conclusions:This predictive model for neonatal hypoxic-ischemic encephalopathy provides a sliding scale of probabilities that could be used for prognostication and to design eligibility criteria for decision making including neuroprotective therapy.展开更多
To calculate incidence rates of pyloric stenosis (estimated by the rate of pyloromyotomy) among infants in Ontario and determine their association with population sociodemographic indicators. Methods: Pyloromyotomy ra...To calculate incidence rates of pyloric stenosis (estimated by the rate of pyloromyotomy) among infants in Ontario and determine their association with population sociodemographic indicators. Methods: Pyloromyotomy rates were calculated from hospital discharge data from 1993 through 2000. Four-year data (1993- 1996 and 1997- 2000) were combined to ensure the stability of the rates. Small-area variations in pyloromyotomy rates and correlations between sociodemographic indicators were studied. Results: Approximately 84.0% of the patients were male infants (younger than 1 year). The sex-adjusted pyloromyotomy rates were 1.57 and 1.86 per 1000 with a 3.4- fold and 3.0- fold regional variation in 1993- 1996 and 1997- 2000, respectively. Urban areas consistently had the lowest pyloromyotomy rate (1.04 and 1.11 per 1000 in Metropolitan Toronto), but the highest rates were from more rural areas (3.30 and 3.38 per 1000 in Quinte, Kingston, Rideau). After adjusting for socioeconomic status and availability of surgeons in the region, living in a rural area remained a significant factor associated with a higher incidence of pyloromyotomy. The risk of pyloromyotomy for an infant who lives in a region with more than two thirds of its area classified as rural was 1.79 (95% confidence interval, 1.23- 2.61; P<.005). Conclusions: The observed changes in incidence and a higher rate among male infants are consistent with results from previous comparative studies conducted in North America and Sweden. The rural/urban differences suggest that environmental influences related to living in these areas may have a role in the etiology of pyloric stenosis. Further research is needed to evaluate these differences.展开更多
Inguinal hernia repair is the most common operation performed in children. The aim of this study was to determine if there are any differences in outcome when this procedure is performed by subspecialist pediatric sur...Inguinal hernia repair is the most common operation performed in children. The aim of this study was to determine if there are any differences in outcome when this procedure is performed by subspecialist pediatric surgeons when compared with general surgeons. All pediatric inguinal hernias repaired in the province of Ontario between 1993 and 2000 were reviewed using a population-based database. Children with complex medical conditions or prematurity were excluded. Cases done by general surgeons were compared with those done by pediatric surgeons. The χ2 test was used for nominal data and the Student’s t test was used for continuous variables. Probabilities were calculated based on a logistic regression model. Of 20, 545 eligible hernia repairs, 50.3%were performed by pediatric surgeons and 49.7%were performed by general surgeons. Pediatric surgeons operated on 62.4%of children younger than 2 years, 51.8%of children aged 26 years, and 37%of children older than 7 years. Duration of operation, length of hospital stay, and incidence of early postoperative complications were similar among pediatric and general surgeons. The rate of recurrent inguinal hernia was higher in the general surgeon group compared with pediatric surgeons (1.10%vs 0.45%, P <.001). Among pediatric surgeons, the estimated risk of hernia recurrence was independent of surgical volume. There was a significant inverse correlation between surgeon volume and recurrence risk among general surgeons, with the highest volume general surgeons achieving recurrence rates similar to pediatric surgeons. Pediatric surgeons have a lower rate of recurrence after inguinal hernia repair in children. General surgeons with high volumes have similar outcomes to pediatric surgeons.展开更多
Objectives: Antibiotic misuse for viral upper respiratory tract infections (URI) in children is a significant problem.Study design: We determined the influence on antibiotic prescribing of clinical features that may i...Objectives: Antibiotic misuse for viral upper respiratory tract infections (URI) in children is a significant problem.Study design: We determined the influence on antibiotic prescribing of clinical features that may increase concern about possible bacterial infection (age, appearance, fever) in children with URI.We created 16 scenarios of children with URI and distributed them by mail survey to 540 pediatricians and family practitioners in Ontario, Canada.The association of patient clinical features, parental pressure, and physician characteristics with antibiotic prescribing was determined through the use of logistic regression analysis.Results: A total of 257 physicians responded (48%).Poor appearance (OR, 6.50; 95%CI, 5.06 to 3.84), fever above 38.5°C (OR, 1.48; 95%CI, 1.21 to 1.82), and age older than 2 years (OR, 2.27; 95%CI, 1.85 to 2.78) were associated with prescribing, whereas parental pressure was not.Physician characteristics associated with antibiotic use were family practitioner (OR, 1.54; 95%CI, 1.22 to 1.96), increasing number of patients seen per week (OR, 1.05; 95%CI, 1.01 to 1.08 for every 20-patient increase), and increasing physician age (OR, 1.17; 95%CI, 1.11 to 1.24, 5-year increments).Conclusions: Clinical factors, which may lead physicians to be concerned about possible bacterial infection in children, are associated with antibiotic use for pediatric URI.展开更多
文摘Objectives:To construct and validate a model and derive a simple rule that is usable in any birth location for the prediction of outcome of term infants with severe asphyxia. Design:Retrospective cohort study. Setting:Regional outborn neonatal intensive care unit. Participants:Infants with postintrapartum asphyxial hypoxic-ischemic encephalopathy (n = 375). Main Exposures:Clinical and laboratory predictors available at age 4 hours. Main Outcome Measures:A logistic regression model was developed and internally validated (with random sampling and based on the year of birth) for severe adverse outcome,which was defined as death or severe disability (severe cerebral palsy,severe developmental delay,sensorineural deafness,or cortical blindness singly or in com bination). A simple prediction rule was derived from 3 variables. Results:Complete data were available for 302 (92%) of the 345 infants with known outcomes (204 infants with severe adverse outcome). Six independent predictors of outcomes were identified. Using the 3 most significant predictors (chest compressions,age at onset of respiration,and base deficit),severe adverse outcome rates were 46%(95%confidence interval,33%-58%) with none of the 3 predictors,64%(95%confidence interval,54%-73%) with any 1 predictor,76%(95%confidence interval,66%-85%)with any 2 predictors,and 93%(95%confidence interval,81%-99%)-with all of the 3 predictors present. The internal validations revealed a robust model. Conclusions:This predictive model for neonatal hypoxic-ischemic encephalopathy provides a sliding scale of probabilities that could be used for prognostication and to design eligibility criteria for decision making including neuroprotective therapy.
文摘To calculate incidence rates of pyloric stenosis (estimated by the rate of pyloromyotomy) among infants in Ontario and determine their association with population sociodemographic indicators. Methods: Pyloromyotomy rates were calculated from hospital discharge data from 1993 through 2000. Four-year data (1993- 1996 and 1997- 2000) were combined to ensure the stability of the rates. Small-area variations in pyloromyotomy rates and correlations between sociodemographic indicators were studied. Results: Approximately 84.0% of the patients were male infants (younger than 1 year). The sex-adjusted pyloromyotomy rates were 1.57 and 1.86 per 1000 with a 3.4- fold and 3.0- fold regional variation in 1993- 1996 and 1997- 2000, respectively. Urban areas consistently had the lowest pyloromyotomy rate (1.04 and 1.11 per 1000 in Metropolitan Toronto), but the highest rates were from more rural areas (3.30 and 3.38 per 1000 in Quinte, Kingston, Rideau). After adjusting for socioeconomic status and availability of surgeons in the region, living in a rural area remained a significant factor associated with a higher incidence of pyloromyotomy. The risk of pyloromyotomy for an infant who lives in a region with more than two thirds of its area classified as rural was 1.79 (95% confidence interval, 1.23- 2.61; P<.005). Conclusions: The observed changes in incidence and a higher rate among male infants are consistent with results from previous comparative studies conducted in North America and Sweden. The rural/urban differences suggest that environmental influences related to living in these areas may have a role in the etiology of pyloric stenosis. Further research is needed to evaluate these differences.
文摘Inguinal hernia repair is the most common operation performed in children. The aim of this study was to determine if there are any differences in outcome when this procedure is performed by subspecialist pediatric surgeons when compared with general surgeons. All pediatric inguinal hernias repaired in the province of Ontario between 1993 and 2000 were reviewed using a population-based database. Children with complex medical conditions or prematurity were excluded. Cases done by general surgeons were compared with those done by pediatric surgeons. The χ2 test was used for nominal data and the Student’s t test was used for continuous variables. Probabilities were calculated based on a logistic regression model. Of 20, 545 eligible hernia repairs, 50.3%were performed by pediatric surgeons and 49.7%were performed by general surgeons. Pediatric surgeons operated on 62.4%of children younger than 2 years, 51.8%of children aged 26 years, and 37%of children older than 7 years. Duration of operation, length of hospital stay, and incidence of early postoperative complications were similar among pediatric and general surgeons. The rate of recurrent inguinal hernia was higher in the general surgeon group compared with pediatric surgeons (1.10%vs 0.45%, P <.001). Among pediatric surgeons, the estimated risk of hernia recurrence was independent of surgical volume. There was a significant inverse correlation between surgeon volume and recurrence risk among general surgeons, with the highest volume general surgeons achieving recurrence rates similar to pediatric surgeons. Pediatric surgeons have a lower rate of recurrence after inguinal hernia repair in children. General surgeons with high volumes have similar outcomes to pediatric surgeons.
文摘Objectives: Antibiotic misuse for viral upper respiratory tract infections (URI) in children is a significant problem.Study design: We determined the influence on antibiotic prescribing of clinical features that may increase concern about possible bacterial infection (age, appearance, fever) in children with URI.We created 16 scenarios of children with URI and distributed them by mail survey to 540 pediatricians and family practitioners in Ontario, Canada.The association of patient clinical features, parental pressure, and physician characteristics with antibiotic prescribing was determined through the use of logistic regression analysis.Results: A total of 257 physicians responded (48%).Poor appearance (OR, 6.50; 95%CI, 5.06 to 3.84), fever above 38.5°C (OR, 1.48; 95%CI, 1.21 to 1.82), and age older than 2 years (OR, 2.27; 95%CI, 1.85 to 2.78) were associated with prescribing, whereas parental pressure was not.Physician characteristics associated with antibiotic use were family practitioner (OR, 1.54; 95%CI, 1.22 to 1.96), increasing number of patients seen per week (OR, 1.05; 95%CI, 1.01 to 1.08 for every 20-patient increase), and increasing physician age (OR, 1.17; 95%CI, 1.11 to 1.24, 5-year increments).Conclusions: Clinical factors, which may lead physicians to be concerned about possible bacterial infection in children, are associated with antibiotic use for pediatric URI.
