Caner Turan

Integration of radiology and clinical score in pediatric appendicitis

The efficacy of ultrasonography (US) and abdominal X‐ray in combination with Pediatric Appendicitis Score (PAS) is complicated in the diagnosis of acute appendicitis. Abdominal X‐ray is as useful as US with clinical assessment when evaluated by experienced pediatric radiologist in acute appendicitis. The aim of this study was to determine the value of US and abdominal X‐ray for appendicitis in children when combined with clinical assessment based on PAS, and to establish a practical pathway for acute appendicitis in childhood.

Infantil delirium induced by cycloplegic eye drops

Cyclopentolate 1% and tropicamide 1% eye drops are considered to be safe in the pediatric population for the fundus examination and treatment of ocular diseases. Although adverse reactions rarely occur, some of them can be life-threatening such as seizure, delirium, coma, arrhythmia, acute life-threatening event, and death. Here we report 15 months old boy who developed delirium after administration of ocular cyclopentolate 1% drops in both eyes during a routine examination for retinopathy of prematurity. Cyclopentolate is a parasympatholytic drug with actions similar to atropine. With ophthalmic administration of cyclopentolate, severe central nervous system effects and systemic reactions may occur. In order to minimize absorption following instill one or two drops of 1% solution, applying pressure to nasolacrimal sac for 2 to 3 min should be considered. In mild to moderate toxicity, benzodiazepines may be used to control central nervous system findings secondary to anticholinergic effects.

Frequency and outcomes of endotracheal intubation in the pediatric emergency department

Intubation is a core airway skill in Pediatric Emergency Medicine (PEM). The data on pediatric endotracheal intubation in the emergency department, especially in developing countries, is currently very limited. This study was designed to describe the frequency, clinical features and outcomes of pediatric intubation in a large children`s hospital. We performed a retrospective analysis of PEM medical records between January 2014 and December 2015 that involved any attempted intubations of children younger than 18 years. The medical records were reviewed to describe the intubation process, demographics, clinical features and outcomes. A total of 110,000 patients visited our emergency department during the study period. Ninety-one of them (1/1300) were intubated. The median age was 2 years, (F/M: 1) and 25 patients were younger than 12 months. Respiratory failure was the most common indication for intubation (42%), followed by status epilepticus (26%) and sepsis-shock (16%). Mortality was associated with prolonged chest compression (more than 10 minute). A poor outcome was associated with sepsis-shock and cardiac diseases; however, better outcomes were associated with status epilepticus (p < 0.001). The first attempt success (FAS) was achieved in 60/91 (66 %) patients and the FAS rate was also higher in younger patients (p=0.002). The discharge rate of all intubated patients in our study was sixty-four percent. Pediatric residents performed the majority of intubations. A higher FAS rate was associated with younger patients. Favorable outcomes were directly related to duration of cardiopulmonary resuscitation and main diagnosis.