Colin Macarthur

Renal ultrasound findings and vesicoureteral reflux in children hospitalised with urinary tract infection

Aims: To determine the sensitivity, specificity, and predictive values of renal ultrasound findings for vesicoureteral reflux (VUR). Methods: Retrospective review of the ultrasound and voiding cystourethrogram (VCUG) results of 162 children under 5 years of age admitted with their first episode of urinary tract infection (UTI) over a two year period. Ultrasound findings were considered suggestive of VUR if “dilatation of the pelvi-calyces”, “dilatation of the ureters”, or “dilatation of the collecting system” of one or both kidneys was reported. Results: A total of 162 patients were eligible for inclusion (median age 85 days; 71 (44%) were female). The prevalence of VUR was 22%. Ultrasound findings were positive for VUR in 14 of 35 patients with confirmed VUR on VCUG, and positive in 30 of 127 patients without VUR on VCUG. Of 21 patients who had a normal ultrasound but showed VUR on VCUG, 14 had grade II reflux, five grade III reflux, and two grade IV reflux. The sensitivity and specificity of ultrasound in suggesting VUR were 40% and 76%, respectively. The positive predictive value of ultrasound in suggesting VUR was 32%; the negative predictive value was 82%. Conclusion: Renal ultrasound findings are neither sensitive nor specific for VUR in children with a first UTI.

Effectiveness of prophylactic inhaled steroids in childhood asthma: A systematic review of the literature

BACKGROUND There has been no systematic appraisal of the evidence regarding the effectiveness of prophylactic inhaled steroids in childhood asthma. OBJECTIVE We sought to evaluate the effectiveness of prophylactic inhaled steroids in childhood asthma. METHODS A MEDLINE search from January 1966 through December 1996 was used to identify pertinent English-language publications. All randomized, double-blind, placebo-controlled trials of prophylactic inhaled steroid therapy for childhood asthma that included data on clinical outcomes (symptom scores and concomitant drug use) or laboratory outcomes (peak expiratory flow rate) were included. RESULTS In total, 24 of 93 studies retrieved met the inclusion criteria. The overall weighted relative improvement in mean total symptom score (inhaled steroid vs placebo) was 50% (95% confidence interval [CI]: 49%, 51%), the overall weighted relative decrease in mean concomitant beta2-agonist use (inhaled steroid vs placebo) was 37% (95% CI: 36%, 38%), and the overall weighted relative decrease in mean concomitant oral steroid use (inhaled steroid vs placebo) was 68% (95% CI: 66%, 70%). The overall weighted absolute improvement in mean peak expiratory flow rate (inhaled steroid vs placebo) was 38 L/min (95% CI: 34.3 L/min, 41.7 L/min). CONCLUSIONS Prophylactic inhaled steroids are effective, compared with placebo, in improving both clinical and laboratory outcomes in childhood asthma.

Risk factors for severe injuries associated with falls from playground equipment

A case control study design was used to determine the risk factors for severe injuries associated with falls from playground equipment. Children presenting to the Hospital for Sick Children in Toronto because of falls from playground equipment (1995-1996) were identified through daily review of admissions and emergency department visits. Cases were defined as children with a severe injury (AIS > or = 2), whereas, controls were children with a minor injury (AIS < 2). Data on age, sex, socioeconomic status, prior experience on the equipment, previous playground injury, type of equipment, height of fall, undersurface, nature of injury, body part involved, and disposition were collected via telephone interview, field trip measurement, and mailed questionnaire. A total of 126 children were studied--67 cases and 59 controls. There were no differences between the two groups on age, sex, socioeconomic status, prior exposure to the equipment, or previous playground injury. Extremity fractures predominated in the case group, while, facial lacerations predominated in the control group. The median height of fall for cases was 199 cm, compared with 160 cm for controls (P = 0.021). Cases were also more likely to have fallen from a height of > 150 cm (73%), compared with controls (54%), P = 0.027. The majority of cases (82%) and controls (86%) fell onto an impact absorbing undersurface (P = 0.540). The median depth of impact absorbing undersurface, however, for both case and control injuries was 3 cm--well below the recommended safety standards. Height of fall was an important risk factor for severe injury associated with falls from playground equipment. Above 150 cm, the risk of severe injury was increased 2-fold.

Risk factors for unintentional injuries due to falls in children aged 0-6 years: a systematic review.

Objective: To identify risk factors for unintentional injuries due to falls in children aged 0–6 years. Design: A systematic review of the literature. Methods: Electronic databases from 1966 to March 2005 were comprehensively searched to identify empirical research that evaluated risk factors for unintentional injuries due to falls in children aged 0–6 years and included a comparison group. Results: 14 studies met the inclusion criteria. Studies varied by the type of fall injury that was considered (ie, bunk bed, stairway, playground or infant walker) and with respect to the quality of evidence. In general, major risk factors for the incidence or severity of injuries due to falls in children included age of the child, sex, height of the fall, type of surface, mechanism (dropped, stairway or using a walker), setting (day care v home care) and socioeconomic status. Conclusion: Despite a high burden, few controlled studies have examined the risk and protective factors for injuries due to falls in children aged 0–6 years. The only study to examine falls from a population health perspective suggests that age, sex and poverty are independent risk factors for injuries due to falls in children.

Development of a clinical asthma score for use in hospitalized children between 1 and 5 years of age.

The objective of this study was to develop a clinical asthma score (CAS) for use in hospitalized children between 1 and 5 years of age. Formal approaches to item selection and reduction, reliability, discriminatory power, validity, and responsiveness were used. The final CAS consisted of five clinical characteristics: respiratory rate, wheezing, indrawing, observed dyspnea, and inspiratory-to-expiratory ratio. Interrater reliability was high (weighted kappa = 0.82), and the CAS was discriminatory (Fergusons delta = 0.92). The CAS was valid, with a strong correlation with length of hospital stay (Spearmans correlation = 0.47, p < 0.05) and drug dosing interval (Spearmans correlation = -0.58, p < 0.01). The CAS was responsive, with a significant change in CAS from admission to discharge (Wilcoxon signed rank test, p < 0.01). This score, for use in hospitalized preschool children, is reliable, discriminatory, valid, and responsive.

Randomised trial spacer v nebuliser for acute asthma.

Sixty hospitalised children with asthma aged 1-5 years were randomised to spacer or nebuliser. A clinical score was measured at baseline and every 12 hours. There were no differences between groups in the score over time, or secondary outcome measures. The spacer is an effective delivery method for young hospitalised asthmatic children.

Is epidural anesthesia in labor associated with chronic low back pain? A prospective cohort study.

The association between epidural anesthesia during labor and subsequent postpartum low back pain remains unclear.The objective of this follow-up cohort study was to determine whether epidural anesthesia was associated with chronic back pain 1 yr after delivery. We contacted 329 women by telephone and asked them to complete a standardized questionnaire 1 yr (+/- 1 mo) after delivery. One hundred sixty-four women had received epidural analgesia for labor and delivery, and 165 had not. Subjects were asked to quantify their back pain (yes/no, numeric rating score, and interference with daily activities). Differences between the two groups were tested by using the chi squared test and the Mann-Whitney U-test, and logistic regression was used to control for confounding variables. The response rate was 244 of 329 (74%). Responders and nonresponders were similar in their demographic and clinical characteristics. There was no difference in the prevalence of back pain between women who had received epidural anesthesia (12 of 121, 10%) and those who had not (17 of 123, 14%). The adjusted relative risk of low back pain at 1 yr (epidural versus nonepidural) was 0.63 (95% confidence interval 0.25, 1.56). There were also no differences between the two groups on numeric rating scores or level of interference with activities. This prospective follow-up study demonstrated no association between epidural anesthesia for labor and delivery and chronic back pain 1 yr after delivery. Implications: We evaluated the presence of low back pain 1 yr after delivery in two groups of women-those who chose epidural analgesia for labor and those who did not. There was no increased risk of back pain in women who had used epidural analgesia. This finding is consistent with those of other North American studies. (Anesth Analg 1997;85:1066-70)

Development of the Hypertonia Assessment Tool (HAT): a discriminative tool for hypertonia in children

Aim  The aim of this study was to develop a tool to identify paediatric hypertonia subtypes.

Helicobacter pylori and childhood recurrent abdominal pain : community based case-control study

Recurrent abdominal pain (at least three discrete episodes of abdominal pain over a period of three or more months, and of sufficient severity to interrupt normal activities) is a common childhood complaint. We set out to determine the association, if any, between Helicobacter pylori infection and childhood recurrent abdominal pain. Cases and controls were drawn consecutively from the practice populations of six primary care paediatricians in Toronto. (Convenience sampling was used to select paediatricians; they were chosen because of their interest in the study.) Cases were children aged 5-15 years presenting with recurrent abdominal pain; controls were healthy children undergoing a routine check-up or vaccination. Excluded were children with concurrent disease, suspected organic disease, aged under five years, or who had used bismuth in the previous month. All families approached consented to participate. Serum IgG antibodies to H pylori were measured by using a flow microsphere immunofluorescent assay (FMIA) and a commercial immunoassay kit (Bio-Rad Laboratories, Hercules, CA). The FMIA method has been validated in children (100% sensitivity, 97% specificity) against …

URBAN/RURAL VARIATION IN CHILDREN'S BICYCLE-RELATED INJURIES

The objective of this study was to examine bicycle-related injury rates for children living in urban and rural areas. Data on all Canadian children hospitalised because of bicycling-related injuries (1994-1998) were obtained from the Canadian Institute for Health Information (CIHI). Injured children were classified as residing in urban, mixed urban, mixed rural or rural areas. Incidence rates for bicycle-related head injuries and other bicycle-related injuries were calculated. Logistic regression was used to estimate the odds of head injury, controlling for age, sex, socio-economic status (SES), collision with a motor vehicle, and the presence of provincial helmet legislation. In total, 9367 children were hospitalised for a bicycling-related injury over the 4-year-study period. Of these, 21% occurred in rural areas, 18% in mixed rural, 17% in mixed urban, while the remaining 44% occurred in urban areas. The average annual incidence rate for bicycle-related head injuries in children was 18.49 per 100000 for children living in rural areas compared with 10.93 per 100000 for those living in urban areas, 15.49 for children in mixed urban areas and 17.38 for children living in mixed rural areas. This variation may be explained by differences in bicycling exposure, helmet use, hospital admission criteria, or road environments across geographic areas.