Biomedical subjects

Mark A Del Beccaro

Publications and source records attributed to Mark A Del Beccaro.

5 recordsLinked to original sources

PubMed2006

Polymerase chain reaction diagnosis of primary human herpesvirus-6 infection in the acute care setting.

OBJECTIVE: To evaluate the potential utility of identifying primary human herpesvirus (HHV)-6 infection in an emergency department setting by determining the frequency of HHV-6 viremia, diagnostic testing, and empiric treatment of serious bacterial infection (SBI) in HHV-6 viremic children, and concurrent SBI and HHV-6 viremia. STUDY DESIGN: Children under age 2 years and who had a blood specimen taken for evaluation of fever were tested for HHV-6 by polymerase chain reaction (PCR). HHV-6 viremia was defined as detection of HHV-6 DNA in acute plasma. RESULTS: A total of 32 of the 181 subjects (18%) had HHV-6 viremia. Children with HHV-6 viremia frequently underwent procedures for diagnosis and empiric treatment of SBI: 60% had bladder catheterizations, 6% had lumbar punctures, 47% had radiographs, 32% received empiric antibiotics, and 34% were hospitalized. Four of the 32 children with HHV-6 viremia (12.5%) were diagnosed with SBI, although none had a positive culture of blood or cerebrospinal fluid. CONCLUSIONS: Rapid diagnosis of HHV-6 viremia may not serve to adequately differentiate infants with and without SBI in acute care settings. Although no children with HHV-6 viremia had bacteremia or meningitis, it appears that additional criteria are needed to increase the specificity of HHV-6 PCR testing before withholding evaluation for SBI.

Bacterial Infections↗

PubMed2006

Computerized provider order entry implementation: no association with increased mortality rates in an intensive care unit.

OBJECTIVE: Our goal was to determine if there were any changes in risk-adjusted mortality after the implementation of a computerized provider order entry system in our PICU. METHODS: Study was undertaken in a tertiary care PICU with 20 beds and 1100 annual admissions. Demographic, admission source, primary diagnosis, crude mortality, and Pediatric Risk of Mortality III risk-adjusted mortality were abstracted retrospectively on all admissions from the PICUEs database for the period October 1, 2002, to December 31, 2004. This time period reflects the 13 months before and 13 months after computerized provider order entry implementation. Pediatric Risk of Mortality III mortality risk adjustment was used to determine standardized mortality ratios. RESULTS: During the study period, 2533 patients were admitted to the PICU, of which 284 were transported from another facility. The 13-month preimplementation mortality rate was 4.22%, and the 13-month postimplementation mortality rate was 3.46%, representing a nonsignificant reduction in the risk of mortality in the postimplementation period. The standardized mortality ratio was 0.98 vs 0.77, respectively, and the mortality rate for the transported patients was 9.6% vs 6.29%. This yields a nonsignificant mortality risk reduction in the postimplementation period. The standardized mortality ratio was 1.10 preimplementation versus 0.70 postimplementation. Analysis of the 13-month preimplementation versus 5-month postimplementation periods showed a non-statistically significant trend in reduction of mortality for all PICU patients and for transported patients. CONCLUSIONS: Implementation of a computerized provider order entry system, even in the early months after implementation, was not associated with an increase in mortality. Our experience suggests that careful design, build, implementation, and support can mitigate the risk of implementing new technology even in an ICU setting.

Child↗

PubMed2005

Nonfebrile illness seizures: a unique seizure category?

PURPOSE: To describe the clinical characteristics of children with a first-time nonfebrile seizure in the setting of mild illness and to test the hypothesis that these seizures are associated with illness characterized by diarrhea. METHODS: This retrospective cohort study was performed in a pediatric emergency department. Patients ages 6 months to 6 years who were evaluated with first-time seizures were eligible for inclusion. Subjects were divided into three groups on the basis of symptoms accompanying their seizure: febrile (temperature, >38.0 degrees C with seizure), unprovoked (no symptoms of illness), and nonfebrile illness (no fever at the time of seizure, but other symptoms of illness present). RESULTS: Of the 323 children with first-time seizures, 247 (76%) had febrile seizure, 37 (12%) had unprovoked seizures, and 39 (12%) had nonfebrile illness seizures. Children with nonfebrile illness seizures were more likely than children with febrile seizures to have diarrheal illnesses accompanying their seizure (44 vs. 16%; p=0.001). Frequency of cough, rhinorrhea, and rash did not differ significantly between children with febrile and nonfebrile illness seizures. Diagnostic testing for infectious etiologies was not performed frequently in either group. CONCLUSIONS: Nonfebrile illness seizures may represent a distinct group of seizures with unique epidemiology. Further study to define this seizure group better is warranted.

Child, Preschool↗

PubMed2004

Postobstructive pulmonary edema in children.

Children with either acute or chronic upper airway obstruction are at risk for postobstructive pulmonary edema. Appropriate diagnosis and management are important in leading to a good outcome for the patient. We describe 2 cases of postobstructive pulmonary edema caused by brief acute upper airway obstruction. In the first case, a child choked on a hot dog and in the second on a "jawbreaker." Both children developed symptoms of complete upper airway obstruction and were managed initially with the Heimlich maneuver and subsequently developed increased work of breathing associated with an oxygen requirement after relief of the obstruction. Both children were managed in the pediatric intensive care unit and were discharged after resolution of symptoms without sequelae.

Adolescent↗

PubMedDate not supplied

A comparison of time to positive culture and time to clinical identification of serious bacterial infection in infants.

To compare the time to positive culture with the time to clinical detection of serious bacterial infection (SBI) in young infants, a retrospective case series of 949 infants age 0-60 days, who had a body fluid cultured in the emergency department or within 24 hours of admission was analyzed. Times to first report of positive culture and first clinical diagnosis of SBI were compared. Of 44 infants with positive cultures, 48% were clinically diagnosed with SBI at first evaluation. Of 21 infants with cultures reported positive after 24 hours, 14 were already diagnosed with SBI. Infections that altered therapy were identified after 24 and 36 hours in 4 infants and 1 infant, respectively. In infants with SBIs, the time to positive culture is longer than the time to identification of infection.

Bacteria↗