Year : 2019 | Volume
: 3 | Issue : 2 | Page : 21-
Diagnosis and outcomes
Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, 5, Fuxing St., Guishan Dist., Taoyuan
|How to cite this article:|
Chiu CY. Diagnosis and outcomes.Pediatr Respirol Crit Care Med 2019;3:21-21
|How to cite this URL:|
Chiu CY. Diagnosis and outcomes. Pediatr Respirol Crit Care Med [serial online] 2019 [cited 2020 Jan 21 ];3:21-21
Available from: http://www.prccm.org/text.asp?2019/3/2/21/264104
A comprehensive understanding of the diagnosis and outcomes of pediatric pulmonary diseases is important for clinicians. Prompt diagnosis of diseases is crucial for clinicians to make decisions in choosing suitable interventions, providing appropriate therapeutic management options. This issue brings up three articles discussing the diagnosis of pneumonia and obstructive sleep apnea (OSA) in pediatric patients and outcomes of critically ill infants requiring transport.
Pneumonia is an infection that causes inflammation in the lungs and a potentially serious infection in children. Diagnosis of pneumonia includes a complete medical history, physical examination, and a chest radiograph (CXR). The main causes of pneumonia are bacteria, viruses, or fungi. CXRs are the most widely employed test; however, they cannot distinguish between viral and bacterial infections and have a misleading in patients with pulmonary edema, lung agenesis, or pseudopneumonia such as thymus. In children, pneumonia caused by Streptococcus pneumoniae is the most common cause of community-acquired pneumonia. However, following the introduction of the pneumococcal conjugate vaccine, a significant decline in pneumococcal pneumonia appears to have declined, accompanied by an increase in Mycoplasma pneumoniae pneumonia. Understanding the epidemiology of health-care-associated infections and adequate awareness and recognition of pneumonia may provide affected children a prompt and appropriate treatment.
OSA is a potentially serious sleep disorder in children. Polysomnography (PSG) is currently the best approach to diagnose OSA. The apnea–hypopnea index (AHI) is an index used to indicate the severity of sleep apnea. The AHI is the number of apneas or hypopneas recorded during the study per hour of sleep. In contrast, the McGill Oximetry Score (MOS) is a validated measure based on nocturnal pulse oximetry by measuring frequency of desaturations (<90%) and numbers of clusters of desaturations. However, it must be emphasized that MOS is not accurate at detecting OSA in children who do not have such drops in oxygen saturation. Despite this, an abnormal MOS has a 97% positive predictive value at detecting moderate–severe OSA as in this issue. Although nocturnal pulse oximetry is an easy, low-cost screening tool for OSA in children when PSG is not available, the significant night-to-night variability between MOS scores suggests a combination with other techniques for a more reliable result.
In clinical practices, patient transportation is an important component of health-care delivery, especially in critically ill infants. Serious problems may develop in relation to the patient's illness or injury during transport. In emergency situations, it is strongly recommended to assess patients by the transport team to anticipate and prepare for events that may occur during transport. Infants are of those vulnerable populations; however, not all hospitals provide a dedicated specialized emergency medical service for transport. In this issue, patients require intubation or inotropic support during transport appears to be more likely to develop complications, including desaturation, severe hypoxia, and acidosis. This information not only offers insight into the importance of the role of a dedicated transport team in the outcomes of patient transport, but also provides information for improving health policies.
|1||Zar HJ, Andronikou S, Nicol MP. Advances in the diagnosis of pneumonia in children. BMJ 2017;358:j2739.|
|2||Tan TQ, Mason EO Jr., Wald ER, Barson WJ, Schutze GE, Bradley JS, et al. Clinical characteristics of children with complicated pneumonia caused by Streptococcus pneumoniae. Pediatrics 2002;110:1-6.|
|3||Kutty PK, Jain S, Taylor TH, Bramley AM, Diaz MH, Ampofo K, et al. Mycoplasma pneumoniae among children hospitalized with community-acquired pneumonia. Clin Infect Dis 2019;68:5-12.|
|4||Dehlink E, Tan HL. Update on paediatric obstructive sleep apnoea. J Thorac Dis 2016;8:224-35.|
|5||Van Eyck A, Verhulst SL. Improving the diagnosis of obstructive sleep apnea in children with nocturnal oximetry-based evaluations. Expert Rev Respir Med 2018;12:165-7.|
|6||Kulshrestha A, Singh J. Inter-hospital and intra-hospital patient transfer: Recent concepts. Indian J Anaesth 2016;60:451-7.|