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Author(s): Stephen M. Gorga [sup.1] , Rashmi D. Sahay [sup.3] , David J. Askenazi [sup.2] , Brian C. Bridges [sup.4] , David S. Cooper [sup.5] , Matthew L. Paden [sup.6] [...], Objective The aim of this study was to characterize continuous renal replacement therapy (CRRT) utilization on extracorporeal membrane oxygenation (ECMO) and to determine the association of both fluid overload (FO) at CRRT initiation and fluid removal during CRRT with mortality in a large multicenter cohort. Methods Retrospective chart review of all children < 18 years of age concurrently treated with ECMO and CRRT from January 1, 2007, to December 31, 2011, at six tertiary care children&apos;s hospital. Children treated with hemodialysis or peritoneal dialysis were excluded from the FO analysis. Measurements and main results A total of 756 of the 1009 children supported with ECMO during the study period had complete FO data. Of these, 357 (47.2%) received either CRRT or were treated with an in-line filter and thus entered into the final analysis. Survival to ECMO decannulation was 66.4% and survival to hospital discharge was 44.3%. CRRT initiation occurred at median of 1 day (IQR 0, 2) after ECMO initiation. Median FO at CRRT initiation was 20.1% (IQR 5, 40) and was significantly lower in ECMO survivors vs. non-survivors (15.3% vs. 30.5% p = 0.005) and in hospital survivors vs. non-survivors (13.5% vs. 25.9%, p = 0.004). Median FO at CRRT discontinuation was significantly lower in ECMO survivors (23% vs. 37.6% p = 0.002) and hospital survivors vs. non-survivors (22.6% vs. 36.1%, p = 0.002). In ECMO survivors, after adjusting for pH at CRRT initiation, non-renal complications, ECMO mode, support type, center, patient age and AKI, FO at CRRT initiation (p = 0.01), and FO at CRRT discontinuation (p = 0.0002) were independently associated with duration of ECMO. In a similar multivariable analysis, FO at CRRT initiation (adjusted adds ratio [aOR] 1.09, 95% CI 1.00-1.18, p = 0.045) and at CRRT discontinuation (aOR 1.11, 95% CI 1.03-1.19, p = 0.01) were independently associated with hospital mortality. Conclusions In a multicenter pediatric ECMO cohort, this study demonstrates that severe FO was very common at CRRT initiation. We found an independent association between the degree of FO at CRRT initiation with adverse outcomes including mortality and increased duration of ECMO support. The results suggest that intervening prior to the development of significant FO may be a clinical therapeutic target and warrants further evaluation.

The article presents the discussion on olfactomedin 4 positive neutrophils being upregulated following hemorrhagic shock. Topics include organ systems assessement containing pulmonary, renal, hepatic, cardiovascular, and hematologic systems; components of the Denver score containing serum creatinine, total bilirubin, and need for cardiovascular E2 inotropes; and complications including inpatient falls, cardiac arrest or a myocardial infarction, and respiratory failure.

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Purpose: The purpose of this study was to assess changes in medical student knowledge, skills, and beliefs in oral health after participating in an oral health curriculum that included an online learning module, shadowing pediatric dental residents, and applying fluoride varnish. Methods: Third-year medical students completed a precurriculum questionnaire. After completing the online module and clinical experience, students completed a postcurriculum questionnaire. Data were analyzed via descriptive statistics, and outcomes were assessed. Results: There was an improvement in knowledge and oral health-related skills questions postcurriculum. All questions on beliefs toward oral health showed a more agreeable response following the oral health curriculum. Conclusion: Interprofessional collaboration and oral health curriculum integration lead to positively changing the knowledge, attitudes, and skills of medical students. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the prevalence of traumatic dental injuries (TDIs) in the primary dentition that presented to the emergency department (ED) of a level-one trauma center at a children's teaching hospital. Methods: Electronic health records of 1,170 patients with 2,746 traumatic dental injuries who presented to the ED over a 55-month period were reviewed in this retrospective cohort study. A subset of these (541 patients) with multiple injuries in primary teeth were examined. Results: The prevalence of primary tooth injury was 41 percent (1,120 out of 2,746). Most injuries were sustained by males (N equals 311; 57 percent); lateral luxations (N equals 341; 30 percent) were the most common injuries to the primary dentition. The primary maxillary central incisors were the most common teeth to be injured. Concomitant injuries were reported in 50 (4.5 percent) primary teeth. Conclusions: Traumatic dental injuries occurred frequently in the primary dentition, with lateral luxations being reported most often. Over 40 percent of all reported TDIs occurred in the primary dentition. Emergency room providers should be prepared to manage primary tooth TDIs. [ABSTRACT FROM AUTHOR]