Diagnostic accuracy of ICD-9 code 780.2 for the identification of patients with syncope in the emergency department

Purpose

Syncope is a common condition that affects individuals of all ages and is responsible for 1–3% of all emergency department (ED) visits. Prospective studies on syncope are often limited by the exiguous number of subjects enrolled. A possible alternative approach would be to use of hospital discharge diagnoses from administrative databases to identify syncope subjects in epidemiological observational studies. We assessed the accuracy of the International Classification of Diseases, Ninth Revision (ICD-9) code 780.2 “syncope and collapse” to identify patients with syncope.

Methods

Patients in two teaching hospitals in Milan, Italy with a triage assessment for ED access that was possibly related to syncope were recruited in this study. We considered the index test to be the attribution of the ICD-9 code 780.2 at ED discharge and the reference standard to be the diagnosis of syncope by the ED physician.

Results

The sensitivity, specificity, positive and negative predictive values of the ICD-9 code 780.2 to identify patients with syncope were 0.63 (95% confidence interval [CI] 0.58–0.67), 0.98 (95% CI 0.98–0.99), 0.83 (95% CI 0.79–0.87) and 0.95 (95% CI 0.94–0.95), respectively.

Conclusions

The moderate sensitivity of ICD-9 code 780.2 should be considered when the code is used to identify patients with syncope through administrative databases.

     

Secondary Headaches in Children and Adolescents: What Not to Miss

Introduction

Headaches are a common occurrence in childhood and adolescence. Most children presenting with a chief complaint of headache have a self-limited infectious disorder or primary headache syndrome that should not require extensive workup.

Purpose of Review

Differentiating these conditions from other more serious causes of headache in children can sometimes be difficult. This article aims to provide information regarding “red flags” that should indicate a need for concern for disorders that require more urgent evaluation.

Recent Findings

Long-held beliefs about specific “red flags” that have been analyzed in recent years as to their validity and new criteria for the diagnosis of idiopathic intracranial hypertension have been elaborated based on study. These publications are reviewed in this article.

Summary

Knowledge of past and current literature on secondary headache in children, combined with thorough history taking and examination, should help determine when there is concern for a serious secondary cause for headache in children and adolescents and direct workup.

     

Familien von anfallskranken Kindern

Background

Epilepsy has an impact on not only the affected child, but also the whole family, especially the parents.

Aim of the study

To give an overview of the psychosocial impact of a child’s epilepsy on his/her family.

Methods

This overview is based on a selection of primary studies, which were mainly identified by a PubMed search.

Results

Besides various worries, high support needs, and mental health problems on the part of the parents, the epilepsy of a child also leads to stress for their siblings and strains in the relationships within the family. Furthermore, there are several limitations both in everyday life and in the social activities of the affected families. The presence of additional behavioral or health problems in children has been found to be an important factor influencing the impact of epilepsy on families.

Conclusion

In a comprehensive treatment approach for children and adolescents with epilepsy, the disease-related burdens of the family should be taken into account and psychosocial support should be provided.

     

District and School Physical Education Policies: Implications for Physical Education and Recess Time

Background

The relationship between physical education (PE) policies and children’s PE and recess time is not well understood.

Purpose

The purpose of this study is to assess the association of district and school PE policies, the PE environment, and PE and recess time.

Methods

Key informants in 65 schools from 9 states completed instruments assessing district and school PE policies, the school PE environment, and time in PE and recess.

Results

Few significant associations were found between PE policies and PE or recess minutes; no policies were associated with both. A number of PE environmental variables were associated with both policies and time in PE and recess.

Conclusions

PE policies, their implementation, and PE environmental variables can have important implications for recess time. Some school PE environment measures designed to improve PE may result in PE time limitations. Deficiencies in PE and recess time are not likely to be effectively addressed through policy adoption alone.

     

Effect of Bike Lane Infrastructure Improvements on Ridership in One New Orleans Neighborhood

Background

Incorporating cycling into daily life is one way to increase physical activity.

Purpose

This study examined the impact of building new bike lanes in New Orleans to determine whether more people were cycling on the street and with the flow of traffic after bike lanes were built.

Methods

Through direct observation of one intervention and two adjacent streets, observers counted cyclists riding on the street and sidewalk, with and against traffic, before and after installation of the lanes. Data were tallied separately for adults, children, males, females, and by race for each location.

Results

There was an increase in cyclists on all three streets after the installation of the bike lanes, with the largest increase on the street with the new lane. Additionally, the proportion of riders cycling with traffic increased after the lanes were striped.

Conclusions

Bike lanes can have a positive impact in creating a healthy neighborhood.

     

Preoperative neurocognitive evaluation as a predictor of brain tumor grading in pediatric patients with supratentorial hemispheric tumors

Objective

The objective of the present study was to retrospectively evaluate the relationship between tumor grading and a selective evaluation of neurocognitive and behavioral functions in children with supratentorial hemispheric brain tumors.

Methods

Children admitted with a diagnosis of supratentorial hemispheric tumors involving the cerebral hemispheres or the thalamus at the Pediatric Neurosurgery Unit of the Catholic University of Rome between January 2008 and January 2014 were considered for the present study. Exclusion criteria were represented by age less than 2 years, severe neurological deficits, seizures, and a metastatic disease. A selective neurocognitive and behavioral workout was used for children aged less and more than 5 years.

Results

Global cognitive functions as well as selective neurocognitive and behavioral profiles were found to be significantly worse in children with low-grade tumors, compared with those affected by higher-grades histotypes. Frontal locations for cortical tumors and thalamic lesions were significantly related with worse results, with a clear contribution of dominant vs. nondominant hemisphere involvement and an age higher than 5 years.

Conclusions

Preoperative global and selective neurocognitive evaluation might contribute to the prediction of the tumor aggressiveness. Due to a longer clinical history, more benign tumors more frequently arrive to the diagnosis with a neurocognitive compromise in spite of an apparently mild presence of neurological symptoms and signs.

     

Spinal cavernous extradural angiolipoma manifesting as a spontaneous spinal epidural hematoma in a child

Introduction

Angiolipomas are benign tumors usually manifested as subcutaneous nodules. Rarely they may form spinal extradural masses. These spinal cavernous angiolipomas have mostly been described in adults.

Diagnosis

To our knowledge, spinal cavernous angiolipomas have been reported in nine pediatric patients.

Clinical presentation

In this paper, we present a 1-year-old child presenting with a spontaneous spinal epidural hematoma from a spinal cavernous angiolipoma and highlight the importance of conducting a histopathological analysis of spontaneous hematomas in previously healthy children.

     

School Sport Participation Under Two School Sport Policies: Comparisons by Race/Ethnicity,Gender, and Socioeconomic Status

Background

School-based extracurricular sport remains an effective strategy to increase physical activity. However, school sport is often limited to a small number of elite athletes. Few schools provide more inclusive sport programs that offer a wider array of activities regardless of ability.

Purpose

The aim of this study was to examine school sport participation in middle schools (ages 11–14) with contrasting school sport delivery strategies (intramural vs. interscholastic).

Methods

Data were obtained through an online survey administered to students at four public middle schools (grades 6–8) in a southeastern US city (n?=?2,582).

Results

More students participated in school sports at intramural schools. Boys were more likely to participate in after-school sports at intramural schools. Low-income and Black children, two groups at greater risk of physical inactivity and other negative outcomes, had greater participation in intramural programs.

Conclusions

After-school intramural sports in middle school is a promising strategy for increasing sport participation.

     

The effects of long-term medication on growth in children and adolescents with ADHD: an observational study of a large cohort of real-life patients

Background

Children and adolescents with ADHD treated with central stimulants (CS) often have growth deficits, but the implications of such treatment for final height and stature remain unclear.

Methods

Weight and height were assessed multiple times in 410 children and adolescents during long-term treatment with CS, which lasted between 0.9 and 16.1 years. Weight and height measures were converted to z-scores based on age- and sex-adjusted population tables.

Results

CS treatment was associated with (1) a relative reduction in body weight and a temporary halt in growth, (2) a weight and height lag after 72 months compared with relative baseline values. No relation to early start of medication (<6 years), gender, comorbid ODD/CD or emotional disorders was observed.

Conclusions

Treatment with central stimulants for ADHD impacts growth in children and adolescents, and growth should be continuously monitored in patients on chronic treatment with these medications.

     

Nonkonvulsiver Status epilepticus

Background

Nonconvulsive status epilepticus (NCSE) is associated with a poor outcome and is furthermore a diagnostic challenge in routine clinical work.

Objective

Several sets of diagnostic criteria exist. What is the difference between them and which ones have been evaluated? Which concept can be recommended in the light of current knowledge?

Material and methods

A survey on the current literature is provided and a structured approach for diagnosing NCSE is given.

Results

Only one study on evaluation of the diagnostic criteria for NCSE exists, i.?e. the “Salzburg criteria for NCSE”, which were investigated retrospectively in a multicenter study. The diagnosis of NCSE is based on clinical and EEG data. The additional implementation of paraclinical information, such as cerebral imaging, emergency and toxicology laboratories is mandatory.

Conclusion

Currently available criteria enable efficient and effective management of the majority of patients suspected of having NCSE; however, in individual cases it has to be taken into consideration that the criteria can be falsely positive or falsely negative.

     

Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis

Background

Chronic pain patients increasingly seek treatment through mindfulness meditation.

Purpose

This study aims to synthesize evidence on efficacy and safety of mindfulness meditation interventions for the treatment of chronic pain in adults.

Method

We conducted a systematic review on randomized controlled trials (RCTs) with meta-analyses using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the GRADE approach. Outcomes included pain, depression, quality of life, and analgesic use.

Results

Thirty-eight RCTs met inclusion criteria; seven reported on safety. We found low-quality evidence that mindfulness meditation is associated with a small decrease in pain compared with all types of controls in 30 RCTs. Statistically significant effects were also found for depression symptoms and quality of life.

Conclusions

While mindfulness meditation improves pain and depression symptoms and quality of life, additional well-designed, rigorous, and large-scale RCTs are needed to decisively provide estimates of the efficacy of mindfulness meditation for chronic pain.

     

Beyond Distance: Children’s School Travel Mode Choice

Background

Long distance is a leading environmental barrier to walking to school and requires long-term, multilevel interventions. Meanwhile, childhood obesity remains highly prevalent, calling for more immediate solutions.

Purpose

The purpose of this study was to examine attitudinal and environmental correlates of walking to the elementary school, controlling for distance.

Methods

Using parental survey data, 601 child pairs with matched home locations and different school travel modes (walking vs. private automobile) were examined, using conditional logistic regressions.

Results

Despite the same/similar objectively measured distance and home location, perceptions of distance, sidewalk and traffic conditions, park presence, and convenience of walking differed between walkers and automobile users. Parental attitudes and children’s preferences were associated with the odds of walking. Safety concerns (traffic danger, stranger danger, and getting lost) were higher among drivers, but only significant in bivariate analyses.

Conclusions

To promote walking to school, route/street improvements appear promising, but parallel educational and promotional efforts may be needed to address perceptual and attitudinal barriers.

     

Link between overweight/obese in children and youngsters and occurrence of multiple sclerosis

Background/aims

The prevalence of overweight/obesity is a major problem in the world, and the number of MS cases is increasing. This literature study examines the relationship between overweight/obesity in children and adolescents and later occurrence of MS.

Method

This is a complete literature survey. The search database is primarily Pubmed using MeSH terms “multiple sclerosis”, “obesity”, and “overweight”, and text words not to restrict searches.

Results

All included studies show a link between being overweight/obese and the presence of MS among people below 20 years of age. The relation is especially true for young girls. The same relation in boys is not significant.

Conclusion

The literature survey convincingly revealed a link between young overweight/obese and occurrence of MS, in particular for girls. There is a need for more and larger studies to investigate the molecular mechanisms that link obesity and MS.

     

Neurovascular stents in pediatric population

Purpose

The purpose of the study is to analyze the results obtained using stents for the treatment of neurovascular diseases in pediatric patients.

Methods

A retrospective study of 6-year period was undertaken evaluating clinical charts and imaging studies of patients treated with stents because of neurovascular diseases.

Results

Nine patients were managed with 10 stents. Seven children were females. The median age was 11 years. There were four cases of broad neck cerebral aneurysms, a pseudoaneurysm of the cervical internal carotid artery, a vertebro-jugular fistula, two patients with internal carotid artery (ICA) stenosis affecting the cervical and supraclinoid segment, and a vertebral artery dissection. The only complication was a silent posterior communicating artery (PCoA) thrombosis in a PCoA aneurysm treated with two stents. Dual antiplatelet therapy was given after the procedure to avoid in stent thrombosis.

Conclusion

Stents are safe and effective for treatment of neurovascular diseases in children, but studies are needed in order to protocolize the use of antiplatelet drugs in children.

     

Skull fracture mimicking eosinophilic granuloma

Background

Delayed swelling after skull fractures is an uncommon complication following head trauma in children. Classically, growing skull fractures typically present in patients under 3 years of age with progressive subcutaneous fluid collections, or occasionally with neurologic symptoms. We present the case of a healthy 2-year-old boy with a lytic “punched-out” frontal skull lesion. The child presented 2 months after a minor forehead injury for which no medical attention was sought.

Methods

The skull defect had no associated leptomeningeal cyst or brain herniation. Imaging and presentation were thought to be consistent with eosinophilic granuloma. Histologic findings demonstrated a healing skull fracture.

Results

Cranioplasty was performed, and the patient had an uncomplicated postoperative course.

Conclusions

In this report, we describe our experience with this atypical presentation of a healing skull fracture mimicking a typical eosinophilic granuloma.

     

Perceptions of Neighborhood Park Quality: Associations with Physical Activity and Body Mass Index

Background

Parks are important resources for physical activity (PA), yet few studies have examined how perceptions of park characteristics relate to PA and health.

Purpose

This study investigated associations between perceptions of neighborhood park quality and overall moderate-to-vigorous PA (MVPA), park-based PA, and body mass index (BMI).

Methods

Data were collected via questionnaire from 893 households in Kansas City, Missouri.

Results

The newly developed neighborhood park quality scale demonstrated good test–retest and internal reliability. Residents’ perceptions of neighborhood park quality were related to PA and health outcomes. Perceiving parks as a benefit was positively related to overall MVPA and park-based PA and negatively related to BMI. Perceptions of well-used parks were positively related to BMI, while perceived cleanliness was negatively related to park-based PA.

Conclusions

Better measuring and understanding how perceptions of local parks are associated with PA and health can improve appreciation of how parks facilitate active living.

     

Spatial Disparities in the Distribution of Parks and Green Spaces in the USA

Background

Little national evidence is available on spatial disparities in distributions of parks and green spaces in the USA.

Purpose

This study examines ecological associations of spatial access to parks and green spaces with percentages of black, Hispanic, and low-income residents across the urban–rural continuum in the conterminous USA.

Methods

Census tract-level park and green space data were linked with data from the 2010 U.S. Census and 2006–2010 American Community Surveys. Linear mixed regression models were performed to examine these associations.

Results

Poverty levels were negatively associated with distances to parks and percentages of green spaces in urban/suburban areas while positively associated in rural areas. Percentages of blacks and Hispanics were in general negatively linked to distances to parks and green space coverage along the urban–rural spectrum.

Conclusions

Place-based race–ethnicity and poverty are important correlates of spatial access to parks and green spaces, but the associations vary across the urbanization levels.

     

Girls get by with a little help from their friends: gender differences in protective effects of social support for psychotic phenomena amongst poly-victimised adolescents

Purpose

To investigate whether social support is protective for psychotic experiences similarly among poly-victimised adolescent girls and boys.

Methods

We utilised data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative sample of 2232 UK-born twins. Participants were privately interviewed at age 18 about victimisation, psychotic experiences, and social support during adolescence.

Results

Perceived social support (overall and from friends) was found to be protective against psychotic experiences amongst poly-victimised adolescent girls, but not boys. Though boys were similarly protected by family support.

Conclusions

Social support-focused interventions targeting psychotic phenomena amongst poly-victimised adolescents may be more effective for girls.