Tuesday, July 26, 2016

A Blood Test for Sports Head Trauma?

Wouldn't it be nice to have a simple blood test to alert clinicians when an athlete may be getting into trouble with head injuries? Wouldn't it be nicer to have a nutritional supplement to lessen the risk of neurologic damage from sports? Read on.

Source: Oliver JM, Jones MT, Kirk KM, et al. Effect of docosahexaenoic acid on a biomarker of head trauma in American football. Med Sci Sports Exerc. 2016;48(6):974-982; doi:10.1249/MSS.0000000000000875. See AAP Grand Rounds commentary by Dr. Joy Weydert (subscription required).

PICO Question: Among National Collegiate Athletic Association football athletes, do serum neurofilament light levels increase with the number and magnitude of head impacts, and does docosahexaenoic acid attenuate this increase?
Question type: Interventional
Study design: Randomized controlled trial

Tuesday, July 19, 2016

Adoption of Children From Emotionally-Depriving Institutions: Timing Matters?

AAP Grand Rounds doesn't often review articles from social science journals. The format of the article is a bit different, but the story the authors tell us is revealing.

Source: Julian MM, McCall RB. Social skills in children adopted from socially-emotionally depriving institutions. Adopt Q. 2016;19(1):44-62; doi:10.1080/10926755.2015.1088106. See AAP Grand Rounds commentary by Dr. Emily Todd (subscription required).

PICO Question: Among children adopted from institutions, does age of adoption, age of assessment, or gender impact social skills?
Question type: Descriptive
Study design: Survey

Tuesday, July 12, 2016

Do We Need Antibiotics for Skin Abscesses?

At first glance, I thought this article might actually change clinical practice. My hopes were dashed at the third paragraph of the Methods section.

Source: Holmes L, Ma C, Qiao H, et al. Trimethoprim-sulfamethoxazole therapy reduces failure and recurrence in methicillin-resistant Staphylococcus aureus skin abscesses after surgical drainage. J Pediatr. 2016;169:128-134.e1; doi:10.1016/jpeds.2015.10.044. See AAP Grand Rounds commentary by Dr. Rebecca Brady (subscription required).

PICO Question: Among children with uncomplicated skin abscesses treated with trimethoprim-sulfamethoxazole (TMP-SMX) following surgical drainage, do those treated with a 3-day course experience higher failure and recurrence rates as compared to those treated with a 10-day course of TMP-SMX?
Question type: Intervention
Study design: Randomized controlled trial

Tuesday, July 5, 2016

An Old Wives' Tale Debunked? Dehydration and Success of Spinal Tap

These investigators developed an ingenious study to try to answer the question of whether a fluid bolus in young infants might result in higher success rate of lumbar puncture, a premise I've always considered an old wives' tale.

Source: Rankin J, Wang VJ, et al. Intravenous fluid bolus prior to neonatal and infant lumbar puncture. JAMA Pediatr. 2016;170(3); e154636; doi:10.1001/jamapediatrics.2015.4636. See AAP Grand Rounds commentary by Dr. Pamela Okada (subscription required).

PICO Question: Among dehydrated infants aged 0-3 months, does lumbar subarachnoid space size measured by ultrasonography increase 1 hour after IV fluid administration?
Question type: Descriptive
Study design: Prospective cohort

Friday, July 1, 2016

Welcome to July's Evidence eMended

The July issue of AAP Grand Rounds has several interesting article reviews, covering topics like the need for lumbar puncture in infants with febrile seizures, overdiagnosis of asthma, adult cardiovascular disease risk from childhood conditions, and more. I'll be contributing my usual Tuesday discussions on fluid bolus to improve infant lumbar puncture success, follow-up therapy for drained staphylococcal skin abscesses, social skills of institutionalized children, and another biomarker study, docosahexaenoic acid for football head trauma.

I hope everyone in the US has a safe and happy Fourth of July planned, meaning you'll be fresh to absorb all my rantings!

Tuesday, June 28, 2016

A Simple Blood Test for Appendicitis?

Biomarkers are hot stuff these days. Knowing that the clinical diagnosis of appendicitis, especially in young children, is very inaccurate, any improvement to decrease complications and unnecessary procedures would be welcome. But, we're not there yet.

Source: Benito J, Acedo L, Medrano L, et al. Usefulness of new and traditional serum biomarkers in children with suspected appendicitis. Am J Emerg Med. 2016;34(5):871-876; doi:10.1016/j.ajem.2016.02.011. See AAP Grand Rounds commentary by Dr. Erin Bennett (subscription required).

PICO Question: Among children 2-14 years of age with suspected appendicitis, are there biomarkers that accurately predict the absence of acute appendicitis?
Study type: Diagnosis
Study design: Prospective cohort

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

  © Blogger template Shush by Ourblogtemplates.com 2009

Back to TOP