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Objective Conventional pediatric spine MRI protocols have multiple sequences resulting in long acquisition times. Sedation is consequently required. This study evaluates the diagnostic capability of a limited MRI spine protocol for selected common pediatric indications. Methods Spine MRIs at CHEO between 2017 and 2020 were reviewed across pediatric patients younger than four years old. Two blinded neuroradiologists reviewed limited scan sequences and results were independently compared to previously reported findings from the complete imaging series. T2 sagittal sequences from the craniocervical junction to sacrum and T1 axial sequence of the lumbar spine constitute the short protocol, with the outcomes of interest being cerebellar ectopia, syrinx, level of conus, filum 95% in all but identifying a filum 0.91) and specificity (> 0.99) for the detection of cerebellar ectopia, syrinx, fatty filum, and spinal dysraphism. Conclusion This study demonstrates that selected spinal imaging sequences allow for consistent and accurate diagnosis of specific clinical conditions. A limited spine imaging protocol has potential as a screening test to reduce the need for full sequence MRI scans. Further work is needed to determine utility of selected imaging for other clinical indications.

Asthma is a leading cause of emergency department (ED) visits and hospitalizations in children, though many could be prevented. Our study objective was to identify factors from the published literature that are associated with future hospitalization for asthma beyond 30 days following an initial asthma ED visit. We searched CINAHL, CENTRAL, MEDLINE, and Embase for all studies examining factors associated with asthma-related hospitalization in children from January 1, 1992 to February 7, 2022.Selecting Studies: All citations were reviewed independently by two reviewers and studies meeting inclusion criteria were assessed for risk of bias. Data on all reported variables were extracted from full text and categorized according to identified themes. Where possible, data were pooled for meta-analysis using random effects models. Of 2262 studies, 68 met inclusion criteria. We identified 28 risk factors and categorized these into six themes. Factors independently associated with future hospitalization in meta-analysis include: exposure to environmental tobacco smoke (OR = 1.94 95%CI 0.67–5.61), pets exposure (OR = 1.67 95%CI 1.17–2.37), and previous asthma hospitalizations (OR = 3.47 95% CI 2.95–4.07). Additional related factors included previous acute care visits, comorbid health conditions (including atopy), allergen exposure, severe-persistent asthma phenotype, inhaled steroid use prior to ED visit, poor asthma control, higher severity symptoms at ED presentation, warmer season at admission, longer length of stay or ICU admission, and African-American race/ethnicity. We identified multiple factors that are consistently associated with future asthma hospitalization in children and could be used to identify those who would benefit from targeted preventative interventions.

ObjectiveConventional pediatric spine MRI protocols have multiple sequences resulting in long acquisition times. Sedation is consequently required. This study evaluates the diagnostic capability of a limited MRI spine protocol for selected common pediatric indications. MethodsAfter REB approval, records of pediatric patients under 4 years of age who underwent a spine MRI at CHEO between 2017 and 2020 were reviewed. Two neuroradiologists blindly and retrospectively reviewed the T2 sagittal sequences from the craniocervical junction to sacrum and T1 axial sequence of the lumbar spine, to answer specific questions regarding cerebellar ectopia, syrinx, level of conus, filum 95% in all but identifying a filum 0.91) and specificity (>0.99) for the detection of cerebellar ectopia, syrinx, fatty filum, and spinal dysraphism. ConclusionThis study demonstrates that selected spinal imaging sequences allows for consistent and accurate diagnosis of specific clinical conditions. A limited spine protocol reduces acquisition time, potentially avoiding sedation. Further work is needed to determine the utility of selected imaging for other clinical indications.

Asthma emergency department (ED) visits remain frequent among children, prompting ongoing pursuit of preventative strategies.We identified factors associated with future acute asthma ED visits among children who had already received guideline recommended discharge management following a prior asthma ED visit.We performed a retrospective cohort study of children ages 1-17 years with a first asthma ED visit to the Children's Hospital of Eastern Ontario in Canada between September 2014-August 2015. Children who received recommended discharge management including an inhaled corticosteroids prescription and/or an asthma action plan were included. We used multivariable logistic regression to identify factors associated with a future acute asthma visits one year following the first ED visit.Among 909 children with a first asthma ED visit, 24% had a future acute asthma visit within one year. Future acute asthma visits were more likely in children with a nut/peanut allergy (OR 1.76, 95% CI: 1.15, 2.70), higher severity symptoms (OR 2.04, 95% CI: 1.23, 3.39), a primary care physician (OR 2.23, 95% CI: 1.26, 3.93), or a prior diagnosis of asthma (OR 1.53, 95% CI: 1.03, 2.28).Children at risk for repeat acute asthma ED visits despite having a primary care provider and receiving recommended discharge management at their first ED visit can be identified by factors such as having a nut/peanut allergy, a prior asthma diagnosis, and higher severity symptoms at ED presentation. These factors can be used to target more intensive preventative interventions to those most in need.

To review and analyze the clinical outcomes of thermal therapy (≤1.4°C increase in core body temperature) in patients with heart failure (HF). A systematic review and meta-analysis regarding the effects of thermal therapy on HF was done by searching PubMed, Ovid Medline, Ovid Embase, Scopus, and internal databases up to date (2019). Improvement in the New York Heart Association (NYHA) class: Ten studies with 310 patients showed significant improvement in NYHA class. Only 7 among 40 patients remained in Class IV and 99 patients in Class III from 155 patients. Increased patients in lower classes indicate that more patients showed improvement. Sixteen studies on 506 patients showed an overall improvement of 4.4% of left ventricular ejection fraction (LVEF). Four studies reported improved endothelial dysfunction by 1.7% increase in flow-mediated dilation (FMD) on 130 patients. Reduction in blood pressure: Thermal therapy reduced both systolic blood pressure (SBP) and diastolic blood pressure by 3.1% and 5.31%, respectively, in 431 patients of 15 studies. Decrease in cardiothoracic ratio (CTR): Eight studies reported an average of 5.55% reduction of CTR in a total of 347 patients. Improvement in oxidative stress markers: Plasma brain natriuretic peptide (BNP) levels significantly decreased (mean difference of 14.8 pg/dL) in 303 patients of 9 studies. Improvement of quality of life: Among 65 patients, thermal therapy reduced cardiac death and rehospitalization by 31.3%. A slight increase in core body temperature is a promising, noninvasive, effective, and complementary therapy for patients with HF. Further clinical studies are recommended.

Pediatric asthma emergency department (ED) visits and repeat visits place a substantial burden on healthcare. National and provincial level studies demonstrate geographic variation in asthma ED visits and links to marginalization, but preclude translation into practical targeting of healthcare delivery. It is important to understand the relationship between pediatric asthma ED visits and marginalization at a more granular level. To map the city-level geographic variation in pediatric asthma ED visit and re-visit rates at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada and the relationship with marginalization.We performed a single center retrospective cohort study of children ages 1-17 with one or more ED visits for asthma at the CHEO in Ottawa. Using postal codes, we linked patients to census tracts. Per census tract, we mapped pediatric asthma ED visit and re-visit rates within one year and identified overlap with the Ontario Marginalization Index.Of 1,620 children with an index ED visit, 18.5% had a repeat ED visit. We identified 10 hot spot census tracts each for pediatric asthma ED visit and re-visit rates. We identified an overlap between urban hot spots and areas with high ethnic concentration or low dependency.At a granular, city-wide level, pediatric asthma ED visit and re-visit rates are heterogeneous. Urban hot spots, in contrast to rural, have more overlap with marginalization, especially ethnic concentration. These methods can be used in other jurisdictions to inform practical community strategies for geographically-targeted prevention of pediatric asthma-related ED visits in vulnerable areas.Abbreviations:ED:Emergency department;CHEO:Children's Hospital of Eastern Ontario;PRAM:Pediatric Respiratory Assessment Measure;ON-Marg:Ontario Marginalization Index;SES:Socioeconomic status;US:United States.Supplemental data for this article can be accessed at publisher's website.