Michael R. Bye

A retrospective cohort study of pulmonary function, radiographic measures, and quality of life in children with congenital scoliosis: an evaluation of patient outcomes after early spinal fusion.

Study Design. Retrospective cohort study. Objective. The purpose of this study is to evaluate pulmonary function and quality of life (QOL) in children treated with early spinal fusion for progressive congenital scoliosis. Summary of Background Data. The relationships between radiographic measures, pulmonary function tests (PFT), and QOL were examined. Methods. Twenty-one patients with congenital scoliosis treated with early spinal fusion were evaluated using radiographs, PFT, and the Child Health Questionnaire (CHQ) at 12.6 ± 3.5 years. They were 6.9 ± 2.3 years postdefinitive fusion, which occurred at 4.9 ± 3.1 year of age. The cohort was also divided in two groups, “thoracic fusion” (apex above the thoracolumbar T–L junction) and “nonthoracic fusion” (below T–L junction). Results. Forced vital capacity, forced expiratory volume (FEV1), vital capacity (P < 0.0001), and total lung capacity (P = 0.017) were significantly lower compared with healthy children. CHQ scores were significantly lower than in healthy children in physical function (P = 0.036), general health (P = 0.007), physical summary (P = 0.026), and parental impact/emotional (P = 0.01). Correlation analysis showed that the degrees of thoracic curves were negatively correlated with FEV1 (P < 0.05), family activities, role/social physical (P < 0.05), and physical summary (P < 0.01). The degree of kyphosis was negatively correlated with Self-Esteem (P < 0.01). Patients who had thoracic fusions had shorter spinal height (P = 0.049), lower forced vital capacity (P = 0.004), FEV (P = 0.012), vital capacity (P = 0.031), and reported more pain (P = 0.033) than nonthoracic fused. Conclusion. Compared with healthy peers, congenital scoliosis patients treated with early spinal fusion have worse PFT and QOL scores at 6.9 years follow up. Patients with thoracic fusions had shorter spines, worse pulmonary function, and more pain than nonthoracic fused. The results may support alternatives to early spinal fusion such as growing rods, epiphysiodesis, and distraction thoracoplasty. Current efforts are underway to compare outcomes of this study to those of other treatments.

Massive Pulmonary Embolism in Children

We present 3 children with massive pulmonary embolism and review 17 recent pediatric reports. Malignancies were a frequent cause (40%), and sudden death was common (60%). Compared with adults, diagnosis was more likely to be made at autopsy (P < .0001), more children were treated with embolectomy/thrombectomy (P = .0006), and mortality was greater (P = .03).

Lack of Association Between Atelectasis and Fever

Because the authors relied on paired sera instead of viral culture for diagnosis, they were unable to detect rhinovirus infection. Details on 31 children with stable asthma are reported. These children did not require steroids but were taking cromolyn, ketotifen (an oral antiinflammatory agent), oral aminophylline, or oral isoproterenol. Subjects received neither antibiotics nor corticosteroids during the acute disease. Airflow obstruction as measured by a decrease in FEVy (the forced expired volume in 1 sec-