Tuesday, June 21, 2016

Parents Are Misusing Car Seats - Does It Matter?

This study confirms and extends our understanding of how care seats are used, with virtually all new parents making errors in utilizing car safety seats (CSSs). However, this isn't the outcome of greatest interest to families of young children.

Source: Hoffman BD, Gallardo AR, Carlson KF. Unsafe from the start: serious misuse of car safety seats at newborn discharge. J Pediatr. 2016;171:48-54; doi:10.1016/j.jpeds.2015.11.047. See AAP Grand Rounds commentary by Dr. Allison Black (subscription required).

PICO Question: Among families with healthy newborn infants, how prevalent is car safety seat misuse, and what variables are associated with car safety seat misuse?
Question type: Descriptive
Study design: Prospective observational

Tuesday, June 14, 2016

More on Food Allergy, and Why There's No Such Thing as a Perfect Study

Wouldn't you figure that a randomized controlled trial published in the New England Journal of Medicine would yield information that is immediately useful in the clinical setting? Guess again. A combination of study design issues, and, likely, the wonderful but maddening inconsistencies in biology, frustrate us again.

Source: Perkin MR, Logan K, Tseng A, et al. Randomized trial of introduction of allergenic foods in breast-fed infants. N Engl J Med. 2016; 374:1733-43. doi:10.1056/NEJMoa1514210. See AAP Grand Rounds commentary by Drs. Neal LeLeiko and Michael Herzlinger (subscription required).

PICO Question: Among breastfed infants, does the introduction of allergenic foods at 3 months of age protect against the development of food allergy as compared those who exclusively breastfeed until approximately 6 months of age?
Question type: Intervention
Study design: Randomized controlled trial

Tuesday, June 7, 2016

Long--Lasting Protection from Peanut Allergy

Don't let the preposterous acronym nomenclature for this study deter you from looking closely at the report; it's an important step forward in preventing peanut allergy in children.

Source: Du Toit G, Sayre PH, Roberts DM, et al. Effect of avoidance on peanut allergy
after early peanut consumption. NEngl J Med. 2016;374(15):1435-1443; doi:10.1056/NEJMoa1514209. See AAP Grand Rounds commentary by Drs. Neal LeLeiko and Michael Herzlinger (subscription required).

PICO Question: Among 6-year-old children who experienced early introduction of peanuts during the first 5 years of life followed by a 12-month period of peanut avoidance, does the rate of peanut allergy differ from those with no exposure to peanuts during the first 5 years of life?
Question type: Intervention
Study design: Follow-up study of randomized controlled trial

Wednesday, June 1, 2016

Welcome to the June's Evidence eMended

June's issue of AAP Grand Rounds is on the shelves, with a boatload of new commentaries for articles covering prenatal seafood intake, outcomes following cardiac arrest in children, impact of pre-transfer CT scanning in pediatric trauma (spoiler alert - don't bother, just transfer to the trauma center), adenotonsillectomy effects on nocturnal enuresis, and many more.

In June's blogs, I'll be focusing on 2 studies looking at different aspects of food allergy as well as carseat use at newborn discharge and use of biomarkers in appendicitis. Please join me!

Tuesday, May 31, 2016

I'll Be Sleeping Well with This BED-FRAME for Diagnostic Tests

As much as I poke fun at contrived acronyms, I confess to favor this one. I felt like I was in Nerd Nirvana after reading this early release article:

Evans SR, Pennello G, Pantoja-Galicia N, et al. Benefit-risk evaluation for diagnostics: a framework (BED-FRAME). Clin Infect Dis 2016; May 18. pii:ciw239; Epub ahead of print.


Tuesday, May 24, 2016

Childhood Cancer Survivors - An Example of the Ecological Fallacy?

This retrospective cohort study is an important contribution to the literature, but also serves to highlight the perils of retrospective studies.

Source: Armstrong GT, Chen Y, Yasui Y, et al. Reduction in late mortality among 5-year survivors of childhood cancer. N Engl J Med. 2016;374(9):833-842; doi:10.1056/NEJMoa1510795. See AAP Grand Rounds commentary by Dr. Mary-Jane Staba Hogan (subscription required). 

PICO Question: Among children surviving ≥5 years after childhood cancer for which treatment was initiated from 1970-1999, what is the cumulative incidence of, and factors associated with, late mortality?
Question type: Descriptive
Study design: Retrospective cohort

Tuesday, May 17, 2016

Oxygen Saturation Targets in Premature Infants - The Never-Ending Story?

This article is the latest in a series of randomized controlled trials attempting to find the safest target oxygen saturations for premature infants. It's also an extremely complex study design and report, pretty challenging to wade through, but perhaps brings us closer to the "real answer."

Source: The BOOST-II Australia and United Kingdom Collaborative Groups. Outcomes of two trials of oxygen-saturation targets in preterm infants. NEJM. 2016;374(8):749-760; doi:10.1056/NEJMoa1514212. See AAP Grand Rounds commentary by Dr. Jonathan Mintzer (subscription required).

PICO Question: Among premature infants < 28 weeks gestational age, what are effects of oxygen saturation target ranges (85-89% vs 91-95%) on death or disability at 2 years corrected age?
Question type: Intervention
Study design: Randomized controlled trial

Tuesday, May 10, 2016

Dental Injuries in High School Sports - The Case of the Missing Denominators

Recently I helped care for a high school lacrosse player who developed mandibular osteomyelitis following wisdom tooth surgery. Once her condition was clearly headed for the better, her main focus was on when she could return to play, less so on protective equipment to prevent injury to that site.

Source: Collins CL, McKenzie LB, Ferketich AK, et al. Dental injuries sustained by high school athletes in the United States, from 2008/2009 through 2013/2014 academic years. Dent Traumatol. 2016;32(2):121-127; doi:10.1111/edt.12228. See AAP Grand Rounds commentary by Dr. Jeffrey Karp (subscription required).

PICO Question: Among US high school athletes, what is the rate of dental injury and how common is mouthguard use?
Question type: Descriptive
Study design: Prospective surveillance

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