Publications by authors named "Romaine F Johnson"

45 Publications

Weight Gain and Severe Obstructive Sleep Apnea in Adolescents with Down Syndrome.

Laryngoscope 2021 Apr 16. Epub 2021 Apr 16.

Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.

Objectives/hypothesis: To determine whether the severity of obstructive sleep apnea (OSA) is affected by weight gain velocity (WGV) in adolescents with Down syndrome.

Study Design: Retrospective case series.

Methods: We performed a retrospective case series of children with Down syndrome, aged 9-19, referred for polysomnography (PSG) due to suspected OSA at an academic children's hospital. We determined the velocity (slope of change) of yearly weight gain using a mixed effect linear regression model. Subsequently, we determined if velocity of yearly weight gain was greater in adolescents with severe OSA (apnea-hypopnea index > 10). Significance was set at P < .05.

Results: A total of 77 adolescents with Down syndrome were identified. The average age was 12.5 years (standard deviation = 3.1); 44 (57%) were male and 46 (60%) were Hispanic. The majority, 51 (66%) had severe OSA. The velocity of yearly weight gain prior to PSG in Down syndrome adolescents was similar regardless of OSA severity (mean diff in weight gain at PSG between severe and nonsevere OSA = -1.42, 95% confidence interval = -5.8 to 2.9, P = .52). Down syndrome adolescents with severe OSA weighed more at PSG (58.4 kg vs. 40.9 kg, P < .001) and all years prior to PSG. These findings remained even when controlling for age at PSG.

Conclusions: Severe OSA in adolescents with Down syndrome is associated with weight. There was no significant difference in WGV in children with Down syndrome with or without severe OSA.

Level Of Evidence: 3 Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29575DOI Listing
April 2021

The Impact of Socioeconomic Disadvantage on Pediatric Tracheostomy Outcomes.

Laryngoscope 2021 Apr 16. Epub 2021 Apr 16.

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.

Objectives: To determine if socioeconomic disadvantage impacts perioperative outcomes after tracheostomy.

Methods: We performed a retrospective case series of children who underwent tracheostomy. Children were divided into less and more disadvantaged groups based on their community's Area Deprivation Index (ADI), a validated socioeconomic vulnerability measure. Primary outcomes were the length of stay, total cost, in-hospital mortality, and 30-day all-cause readmission after tracheostomy placement. Length of stay was further analyzed using parametric survival analysis.

Results: A total of 239 patients met inclusion criteria, with 153 (64%) residing in more disadvantaged communities. Children from more disadvantaged communities were less likely to be White (42% vs. 26%, P = .009) and more likely to have Medicaid coverage (90% vs. 62%, P < .001). The two groups had similar medical complexity and comorbidities. The main outcome measures showed differences in median total length of stay (113 vs. 79 days, P = .04) and median total cost ($461 000 vs. $279 000, P = .01). Children with tracheostomies who were from more disadvantaged communities also had increased risk of prolonged hospitalizations (HR = 0.63, 95% CI = 0.48-0.83, P = .001). Readmissions, mortality rates, and quality of life scores were similar between groups.

Conclusions: Community disadvantage was associated with differences in hospitalization length and costs after pediatric tracheostomy placement. Further research should continue to describe how health disparities impact children's safe and efficient care with tracheostomies.

Level Of Evidence: 4 Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29576DOI Listing
April 2021

Comparing Long-Term Outcomes in Tracheostomy Placed in the First Year of Life.

Laryngoscope 2021 Feb 10. Epub 2021 Feb 10.

Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.

Objectives//hypothesis: To characterize long-term outcomes in pediatric patients requiring tracheotomy in the first year of life.

Study Design: Retrospective case series.

Methods: A retrospective longitudinal registry of tracheostomy patients was queried for patients who underwent tracheotomy from birth to 11 months. Primary outcomes were decannulation and survival. Secondary outcomes included neurocognitive quality of life assessed with the PedsQL Family Impact Module (scored from worst to best, 0 to 100 points).

Results: The study included 337 children. Thirty (8.90%) were neonates and 307 (91.10%) were infants. The population was 56.08% male (n = 189), and the racial and ethnicity composition were equally distributed (29.97% White, 31.45% Black, and 31.16% Hispanic). Significant differences between neonates and postneonates included birth weight in grams (2,731.40 vs. 1,950.44, P < .05), extreme prematurity (13.33% vs. 38.88%, P = .01), upper airway obstruction (80.00% vs. 42.67%, P < .05), and the need for mechanical ventilation (40.00% vs. 83.71%, P < .05). Despite these differences, long-term outcomes were similar: decannulation (X = 2.19, P = .14), death (X = 2.63, P = .11), and neurocognitive quality of life (X = 2.63, P = .27). Having a child with a tracheostomy caused the most problems with being physically tired (mean = 75.32 ± 3.90), emotional frustration (mean = 77.31 ± 5.05), and worry (mean standard deviation = 74.23 ± 6.48).

Conclusion: There were demographic differences between neonatal and infantile tracheostomy patients, but they did not affect long-term outcomes. The presence of a tracheostomy caused a significant impact on a family's quality of life.

Level Of Evidence: 3. Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29440DOI Listing
February 2021

Perioperative Outcomes After Tracheostomy Placement Among Complex Pediatric Patients.

Laryngoscope 2021 Jan 19. Epub 2021 Jan 19.

Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.

Objectives/hypothesis: To compare perioperative outcomes after pediatric tracheostomy placement based on patient complexity.

Study Design: Retrospective case series.

Methods: All patients that underwent tracheostomy placement at a tertiary children's hospital between 2015 and 2019 were followed. Children with a history of major cardiac surgery, sepsis, or total parental nutrition (TPN) were grouped as complex. Admission length, tracheostomy-related complications, in-hospital mortality, and 30-day readmissions were recorded among complex and non-complex patients.

Results: A total of 238 children were included. Mean age at tracheostomy was 39.9 months (SD: 61.3), 51% were male and 51% were complex. Complex patients were younger at admission (29.9 vs. 46.8 months, P = .03), more likely to have respiratory failure (81% vs. 53%, P < .001) and more often required mechanical ventilation at discharge (86% vs. 67%, P < .001). An additional 33 days after placement was required for complex children (95% CI: 14-51, P = .001) and this group had more deaths (8% vs. 1%, P = .02); however, both groups had similar complication and readmission rates (P > .05). Total charges were higher among complex patients ($700,267 vs. $338,937, P < .001). Parametric survival analysis identified mechanical ventilation and patient complexity interacting to predict post-tracheostomy admission length.

Conclusions: Hospital discharge after pediatric tracheostomy was associated with patient complexity and further influenced by mechanical ventilation. Recognition that cardiac surgery, sepsis, or TPN can predict poorer perioperative outcomes can provide quality improvement strategies for these vulnerable children.

Level Of Evidence: 4 Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29402DOI Listing
January 2021

Determining the Odds of Difficult Airway Resolution Among Pediatric Patients: A Case Series.

Otolaryngol Head Neck Surg 2021 Jan 19:194599820986570. Epub 2021 Jan 19.

Children's Health System of Texas, Dallas, Texas, USA.

Objective: We sought to determine the patient factors that contribute to the improvement and resolution of difficult airways in pediatric patients.

Study Design: The hospital's Multidisciplinary Airway Registry Committee was created in November 2006 to develop a process for recognition and management of children with difficult airways. A database of these patients is actively maintained, allowing for statistical data analysis.

Setting: The tertiary care hospital system consists of 2 campuses serving the indigent pediatric population of the greater Dallas metropolitan area and performs an average of 40,000 anesthetic encounters per year.

Methods: We examined the data from a difficult airway database from a major tertiary care pediatric hospital to determine patient factors that led to airway improvement over time. Patients enrolled in the registry from November 2006 to October 2019 due to difficulties with intubation or mask ventilation were studied through statistical analysis.

Results: A total of 579 patients were identified. The Kaplan-Meier estimate of the 5-year deactivation rate was 14%. The most common reason for deactivation in our cohort was resolution of the difficult airway as defined by direct laryngoscopy Cormack and Lehane grade I or IIa/IIb, easy mask ventilation or laryngeal mask placement, or resolution of subglottic stenosis.

Conclusion: Advancing age and male sex at the time of enrollment were the most important predictors of an airway remaining difficult.
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http://dx.doi.org/10.1177/0194599820986570DOI Listing
January 2021

Systemic Bevacizumab for Treatment of Respiratory Papillomatosis: International Consensus Statement.

Laryngoscope 2021 Jun 6;131(6):E1941-E1949. Epub 2021 Jan 6.

Department of Otolaryngology-Head and Neck Surgery, University of Texas (UT) Southwestern Medical Center, Dallas, Texas, U.S.A.

Objectives/hypothesis: The purpose of this study is to develop consensus on key points that would support the use of systemic bevacizumab for the treatment of recurrent respiratory papillomatosis (RRP), and to provide preliminary guidance surrounding the use of this treatment modality.

Study Design: Delphi method-based survey series.

Methods: A multidisciplinary, multi-institutional panel of physicians with experience using systemic bevacizumab for the treatment of RRP was established. The Delphi method was used to identify and obtain consensus on characteristics associated with systemic bevacizumab use across five domains: 1) patient characteristics; 2) disease characteristics; 3) treating center characteristics; 4) prior treatment characteristics; and 5) prior work-up.

Results: The international panel was composed of 70 experts from 12 countries, representing pediatric and adult otolaryngology, hematology/oncology, infectious diseases, pediatric surgery, family medicine, and epidemiology. A total of 189 items were identified, of which consensus was achieved on Patient Characteristics (9), Disease Characteristics (10), Treatment Center Characteristics (22), and Prior Workup Characteristics (18).

Conclusion: This consensus statement provides a useful starting point for clinicians and centers hoping to offer systemic bevacizumab for RRP and may serve as a framework to assess the components of practices and centers currently using this therapy. We hope to provide a strategy to offer the treatment and also to provide a springboard for bevacizumab's use in combination with other RRP treatment protocols. Standardized delivery systems may facilitate research efforts and provide dosing regimens to help shape best-practice applications of systemic bevacizumab for patients with early-onset or less-severe disease phenotypes.

Level Of Evidence: 5 Laryngoscope, 131:E1941-E1949, 2021.
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http://dx.doi.org/10.1002/lary.29343DOI Listing
June 2021

International Pediatric Otolaryngology Group (IPOG) management recommendations: Pediatric tracheostomy decannulation.

Int J Pediatr Otorhinolaryngol 2021 Feb 15;141:110565. Epub 2020 Dec 15.

Division of Otolaryngology, Children's National Medical Center, George Washington University, Washington DC, USA.

Objectives: To provide recommendations to otolaryngologists, pulmonologists, and allied clinicians for tracheostomy decannulation in pediatric patients.

Methods: An iterative questionnaire was used to establish expert recommendations by the members of the International Pediatric Otolaryngology Group.

Results: Twenty-six members completed the survey. Recommendations address patient criteria for decannulation readiness, airway evaluation prior to decannulation, decannulation protocol, and follow-up after both successful and failed decannulation.

Conclusion: Tracheostomy decannulation recommendations are aimed at improving patient-centered care, quality and safety in children with tracheostomies.
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http://dx.doi.org/10.1016/j.ijporl.2020.110565DOI Listing
February 2021

Competency-Based Assessment Tool for Pediatric Esophagoscopy: International Modified Delphi Consensus.

Laryngoscope 2021 05 9;131(5):1168-1174. Epub 2020 Oct 9.

Department of Otolaryngology, Head and Neck Surgery, Stanford University, Lucile Salter Packard Children's Hospital, Palo Alto, California, U.S.A.

Objectives/hypothesis: Create a competency-based assessment tool for pediatric esophagoscopy with foreign body removal.

Study Design: Blinded modified Delphi consensus process.

Setting: Tertiary care center.

Methods: A list of 25 potential items was sent via the Research Electronic Data Capture database to 66 expert surgeons who perform pediatric esophagoscopy. In the first round, items were rated as "keep" or "remove" and comments were incorporated. In the second round, experts rated the importance of each item on a seven-point Likert scale. Consensus was determined with a goal of 7 to 25 final items.

Results: The response rate was 38/64 (59.4%) in the first round and returned questionnaires were 100% complete. Experts wanted to "keep" all items and 172 comments were incorporated. Twenty-four task-specific and 7 previously-validated global rating items were distributed in the second round, and the response rate was 53/64 (82.8%) with questionnaires returned 97.5% complete. Of the task-specific items, 9 reached consensus, 7 were near consensus, and 8 did not achieve consensus. For global rating items that were previously validated, 6 reached consensus and 1 was near consensus.

Conclusions: It is possible to reach consensus about the important steps involved in rigid esophagoscopy with foreign body removal using a modified Delphi consensus technique. These items can now be considered when evaluating trainees during this procedure. This tool may allow trainees to focus on important steps of the procedure and help training programs standardize how trainees are evaluated.

Level Of Evidence: 5. Laryngoscope, 131:1168-1174, 2021.
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http://dx.doi.org/10.1002/lary.29126DOI Listing
May 2021

The Family Impact of Having a Child with a Tracheostomy.

Laryngoscope 2021 04 14;131(4):911-915. Epub 2020 Aug 14.

Children's Health Airway Management Program, Children's Medical Center Dallas, Dallas, Texas, U.S.A.

Objectives: Measure the quality of life among families with children with tracheostomies.

Methods: We performed a prospective cross-sectional analysis of families with children with tracheostomies utilizing the PedQL Family Impact Module-a validated quality of life assessment. We determined if scores were impacted by demographics using regression analysis. We also compared the tracheostomy sample's scores to a previously published cohort of children with severe cerebral palsy and birth defects that required home nursing or nursing home placement using the student's t-test. We determined the effect size of the difference between the two groups using the Cohen's d test.

Results: Ninety-eight families are included in the study. The average (SD) age of tracheostomy placement was 1.6 (3.5) years. The population was 60% (59/98) male and 39% (38/98) Hispanic. The principal reason for tracheostomy was due to respiratory failure (76 out of 98; 78%). The mean (SD) total Family Impact score was 76 (19). The lowest domain score was daily activity problems, mean (SD) = 67 (30) followed by worry (mean = 69, SD = 24). The lowest question score was, "I worry about my child's future," mean (SD) = 52 (37). When compared to the comparison group of medically fragile children, the scores were statistically similar except for communication totals where tracheostomy patients reported superior scores (78.3 vs. 62.9, 95% CI, -26 to -4.8, P = .005, Cohen's d = -0.66).

Conclusion: The presence of a tracheostomy is associated with QOL scores like other medically fragile children.

Level Of Evidence: 4 Laryngoscope, 131:911-915, 2021.
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http://dx.doi.org/10.1002/lary.29003DOI Listing
April 2021

The Incidence of Pediatric Tracheostomy and Its Association Among Black Children.

Otolaryngol Head Neck Surg 2021 01 11;164(1):206-211. Epub 2020 Aug 11.

Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA.

Objective: In 2012, Black or African American children constituted 21% of pediatric tracheostomies while representing approximately 15% of the US population. It is unclear if this discrepancy is due to differences in associated diagnoses. This study aimed to analyze the incidence of pediatric tracheostomy in the United States from 2003 to 2016 and to determine the odds of placement among Black children when compared with other children.

Study Design: Retrospective.

Setting: Academic hospital.

Subjects And Methods: We used the 2003 to 2016 Kid Inpatient Database to determine the incidence of pediatric tracheostomy in the United States and determine the odds of tracheostomy placement in Black children when compared with other children.

Results: A total of 26,034 pediatric tracheostomies were performed between 2003 and 2016, among which, 21% were Black children. The median age was 7 years (interquartile range [IQR] = 0 to 17); 43% were ≤2 years old, and 62% were male. The most common principal diagnosis was respiratory failure (72%). When compared with other children, Black children were more likely to undergo tracheostomy (odds ratio [OR] = 1.2; 95% CI, 1.1-1.3), which increased among children younger than 2 years old (OR = 1.5; 95% CI, 1.4-1.5). Black children with tracheostomies were also more likely to be diagnosed with laryngeal stenosis and bronchopulmonary dysplasia and to have an extended length of stay ( < .001).

Conclusion: Black children are 1.2 times more likely to undergo tracheostomy in the United States compared with other children. Further investigation is warranted to evaluate if there are underlying anatomical, environmental, or psychosocial factors that contribute to this discrepancy.
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http://dx.doi.org/10.1177/0194599820947016DOI Listing
January 2021

A Longitudinal Analysis of Outcomes in Tracheostomy Placement Among Preterm Infants.

Laryngoscope 2021 02 11;131(2):417-422. Epub 2020 Jul 11.

Department of Otolaryngology - Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A.

Objectives: To study a case series of preterm and extremely preterm infants, comparing their decannulation and survival rates after tracheostomy.

Methods: We performed a single-institution longitudinal study of preterm infants with a tracheostomy. Infants were categorized as premature (born > 28 weeks and < 37 weeks) and extremely premature (born ≤ 28 weeks). Decannulation and survival rates were determined using the Kaplan-Meier method. Neurocognitive quality of life (QOL) was reported as normal, mild/moderately, and severely impaired. Statistical significance was set at P < .05.

Results: This study included 240 patients. Of those, 111 were premature and 129 were extremely preterm. The median age (interquartile range) at tracheostomy was 4.8 months (0.4). Premature infants were more likely than extremely preterm to have airway obstruction (54% vs. 32%, P < .001); whereas extremely preterm infants were more likely to have bronchopulmonary dysplasia (68% vs. 15%, P < .001) and to be ventilation-dependent (68% vs. 54%, P < .001). The 5-year decannulation rate for premature infants was 46% and for extremely preterm was 64%. The 5-year survival rate post-tracheostomy for preterm was 79% and for extremely preterm was 73%. The log-rank test of equality showed that decannulation and survival were similar (P > .05) for both groups, even after controlling for potentially confounding factors like race, age, gender, birth weight, and age at tracheostomy. For neurocognitive QOL, 47% of patients survived with severely impaired QOL after tracheostomy. Preterm had 56% with severely impaired QOL and extremely preterm had 40% with severely impaired QOL (P = .03).

Conclusion: This study demonstrated that the time to decannulation and the likelihood of survival did not vary among premature and extremely premature infants even when controlling for other confounding variables.

Level Of Evidence: 3b Laryngoscope, 131:417-422, 2021.
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http://dx.doi.org/10.1002/lary.28864DOI Listing
February 2021

Palatine Tonsilloliths and : A Multi-institutional Study of Adult Patients Undergoing Tonsillectomy.

Otolaryngol Head Neck Surg 2020 10 5;163(4):743-749. Epub 2020 May 5.

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Objective: To better characterize associations between and tonsillolith versus nontonsillolith tonsillectomy specimens.

Study Design: Bi-institutional retrospective case-case study.

Setting: University and county hospital.

Subjects And Methods: Adult patients with a clinical history of tonsilloliths who underwent tonsillectomy from January 2006 to December 2018 were included. Patients undergoing tonsillectomy for tonsillar hypertrophy and chronic tonsillitis were identified as comparative cases. Similarly, patients with ipsilateral oropharyngeal cancer (OPC) who underwent contralateral tonsillectomy of a normal-appearing tonsil for prophylaxis against a second primary cancer were also included as comparative cases.

Results: The study population comprised 134 patients who underwent tonsillectomy: 62 tonsillolith and 72 nontonsillolith (tonsillar hypertrophy, n = 30; chronic tonsillitis, n = 30; normal-appearing contralateral tonsil in patients with ipsilateral OPC, n = 12). was reported in 11% of the patients with tonsilloliths on initial pathology reports but in 95% after re-evaluation (n = 54 of 57). prevalence was significantly higher in patients with tonsilloliths as compared with patients with recurrent tonsillitis (73%, n = 22 of 30, < .001) and normal-appearing contralateral tonsils in patients with ipsilateral OPC (58%, n = 7 of 12, < .001). prevalence was not significantly different between patients with tonsilloliths and tonsillar hypertrophy (83%, n = 25 of 30, = .11).

Conclusion: The prevalence of in tonsillolith tonsil specimens is high; however, routinely colonizes nontonsillolith tonsil specimens. Therefore, is unlikely to be the primary driver of tonsillolith pathogenesis, and targeted treatment of tonsilloliths may not be effective. Treatment strategies addressing tonsilloliths should be further investigated.
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http://dx.doi.org/10.1177/0194599820921392DOI Listing
October 2020

Tonsillectomy Outcomes among Children with Mental Health Disorders in the United States.

Otolaryngol Head Neck Surg 2020 May 3;162(5):754-760. Epub 2020 Mar 3.

Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Objectives: Recent evidence suggests that children with mental health disorders are more likely to have postoperative complications. Our aim was to determine if mental health disorders affect postoperative complications after tonsillectomy with or without adenoidectomy (T&A).

Setting: Cross-sectional analysis of national databases.

Subjects And Methods: The 2006 to 2016 Kids Inpatient Database and the 2014 Nationwide Readmission Database were used to identify children (age <21 years) who underwent T&A. We compared children with mental health disorders (eg, autism, developmental delays, or mood disorders) to those without a mental health disorder. We contrasted gender, race, length of stay, complications, and 30-day readmissions.

Results: We estimated that 37,386 children underwent T&A, and there were 2138 (5.7%) diagnosed with a mental health disorder. Children with mental health disorders were older (6.0 vs 5.3 years, < .001), more commonly males (64% vs 58%, < .001), had a longer length of stay (3.4 days vs 2.3 days, < .001), and had higher total charges even after controlling for length of stay ($19,000 vs $14,000, < .001). Children with a mental health disorder were more likely to have a complication (odds ratio [OR] = 2.1; 95% confidence interval [CI], 1.7 to 3.4; < .001) including intubation, mechanical ventilation, or both (OR = 3.3; 95% CI, 2.6 to 3.8; < .001). The 30-day all-cause readmission rate was higher (12% vs 4.0%, < .001).

Conclusion: Children with mental health disorders, especially development delays, have more frequent complications, longer lengths of stay, and readmissions than children without mental health disorders. This information should be included in preoperative counseling.
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http://dx.doi.org/10.1177/0194599820910115DOI Listing
May 2020

Competency-Based Assessment Tool for Pediatric Tracheotomy: International Modified Delphi Consensus.

Laryngoscope 2020 11 10;130(11):2700-2707. Epub 2019 Dec 10.

Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Pediatric Otolaryngology, Doernbecher Children's Hospital, Portland, Oregon, U.S.A.

Objectives/hypothesis: Create a competency-based assessment tool for pediatric tracheotomy.

Study Design: Blinded, modified, Delphi consensus process.

Methods: Using the REDCap database, a list of 31 potential items was circulated to 65 expert surgeons who perform pediatric tracheotomy. In the first round, items were rated as "keep" or "remove," and comments were incorporated. In the second round, experts were asked to rate the importance of each item on a seven-point Likert scale. Consensus criteria were determined a priori with a goal of 7 to 25 final items.

Results: The first round achieved a response rate of 39/65 (60.0%), and returned questionnaires were 99.5% complete. All items were rated as "keep," and 137 comments were incorporated. In the second round, 30 task-specific and seven previously validated global rating items were distributed, and the response rate was 44/65 (67.7%), with returned questionnaires being 99.3% complete. Of the Task-Specific Items, 13 reached consensus, 10 were near consensus, and 7 did not achieve consensus. For the 7 previously validated global rating items, 5 reached consensus and two were near consensus.

Conclusions: It is feasible to reach consensus on the important steps involved in pediatric tracheotomy using a modified Delphi consensus process. These items can now be considered to create a competency-based assessment tool for pediatric tracheotomy. Such a tool will hopefully allow trainees to focus on the important aspects of this procedure and help teaching programs standardize how they evaluate trainees during this procedure.

Level Of Evidence: 5 Laryngoscope, 130:2700-2707, 2020.
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http://dx.doi.org/10.1002/lary.28461DOI Listing
November 2020

Obstructive Sleep Apnea in Children With Autism.

J Clin Sleep Med 2019 10;15(10):1469-1476

Division of Pediatric Otolaryngology, Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas.

Study Objectives: To describe the demographic and clinical characteristics of children with autism spectrum disorder (ASD) referred for polysomnography (PSG) and to look for predictors of obstructive sleep apnea (OSA) and severe OSA in these children.

Methods: This is a retrospective case series of children ages 2 to 18 years who underwent PSG between January 2009 and February 2015. Children were excluded if they had major comorbidities, prior tonsillectomy, or missing data. The following information was collected: age, sex, race, height, weight, tonsil size, and prior diagnosis of allergies, asthma, gastroesophageal reflux disease, seizure disorder, developmental delay, cerebral palsy, or attention deficit hyperactivity disorder. Predictors of OSA were evaluated.

Results: A total of 45 children were included with a mean (standard deviation [SD]) age of 6.1 years (2.8). The patients were 80% male, 49% Hispanic, 27% African American, 22% Caucasian, and 2.2% other. Of these children 26 (58%) had OSA (apnea-hypopnea index [AHI] > 1 event/h) and 15 (33%) were obese (body mass index, body mass index z-score ≥ 95th percentile). The mean (SD) AHI was 7.7 (15.0) events/h (range 1.0-76.6). A total of 9 (20%) had severe OSA (AHI ≥  10 events/h). There were no demographic or clinical predictors of OSA in this group. However, increasing weight served as a predictor of severe OSA and African American or Hispanic children were more likely obese.

Conclusions: The absence of demographic or clinical predictors of OSA supports using general indications for PSG in children with ASD.
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http://dx.doi.org/10.5664/jcsm.7978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778353PMC
October 2019

Weight gain velocity as a predictor of severe obstructive sleep apnea among obese adolescents.

Laryngoscope 2020 05 30;130(5):1339-1342. Epub 2019 Sep 30.

Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas.

Objectives/hypothesis: To evaluate a cohort of obese adolescents with obstructive sleep apnea (OSA) to determine if increased yearly weight gain was a predictor of severe OSA.

Study Design: Retrospective cohort study.

Methods: Obese adolescents (body mass index percentile >95% for that age and sex based upon the Centers for Disease Control and Prevention weight classifications), ages 12 to 17 years, referred for full night polysomnography (PSG) were analyzed. We examined demographics, weight classifications, yearly weight gain from age 9 years onward, PSG data (apnea-hypopnea index), and tonsil size. We performed a mixed-effect linear regression model to test whether the velocity of weight gain was increased in obese patients with severe OSA when compared to those without severe OSA.

Results: This study included 166 obese adolescents, 105 with and 61 without severe OSA. The average age was 14 years and was predominately male (57%) and Hispanic (44%). The regression analysis found that the yearly change in weight among obese adolescents with severe OSA was significantly higher than those without (B = 1.4, standard error = 0.50, P = .005, 95% confidence interval: 0.42-2.4). For the group with severe OSA, weight increased 6.5 kg every year before their PSG, whereas for those without, weight increased 5.1 kg per year.

Conclusions: The rate of weight gain over time is an important predictor of severe OSA in obese adolescents.

Level Of Evidence: 3b Laryngoscope, 130:1339-1342, 2020.
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http://dx.doi.org/10.1002/lary.28296DOI Listing
May 2020

Tracheostomy in Extremely Preterm Neonates in the United States: A Cross-Sectional Analysis.

Laryngoscope 2020 08 18;130(8):2056-2062. Epub 2019 Sep 18.

Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas.

Objectives/hypothesis: Bronchopulmonary dysplasia (BPD) and invasive respiratory support is increasing among extremely preterm neonates. Yet, it is unclear if there is a corresponding increase in tracheostomies. We hypothesize that in extremely preterm neonates with BPD, the incidence of tracheostomy has increased.

Study Design: Retrospective cross-sectional analysis.

Methods: We analyzed the 2006 to 2012 Kids' Inpatient Databases (KID) for hospital discharges of nonextremely preterm neonates (gestational age >28 weeks and <37 weeks or birth weight >1,500 g) and extremely preterm neonates (gestational age ≤28 weeks or birth weight ≤1,500 g). We studied tracheostomy placement trends in these two populations to see if they are increasing among extremely preterm neonates, especially those with BPD.

Results: The study included 1,418,681 preterm neonates (52% male, 50% white, 19% black, 20% Hispanic, 4.2% Asian), of whom 118,676 (8.4%) were extremely preterm. A total of 2,029 tracheostomies were performed, of which 803 (0.68%) were in extremely preterm neonates. The estimated percent change of occurrence of extremely preterm neonates with BPD increased 17% between 2006 and 2012, and tracheostomy placement increased 31%. Amongst all who received tracheostomies, mortality rate was higher in extremely preterm neonates compared to nonextremely preterm neonates (18% vs. 14%, P = .05). However, in extremely preterm neonates, those with tracheostomies had a lower mortality rate compared to those without (18% vs. 24%, P = .002).

Conclusions: Extremely preterm neonates, compared to nonextremely preterm neonates, experienced a marked increase in tracheostomies placed from 2006 to 2012 as well as an increased incidence of BPD, confirming our primary study hypothesis.

Level Of Evidence: 4 Laryngoscope, 130: 2056-2062, 2020.
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August 2020

Survival analysis and decannulation outcomes of infants with tracheotomies.

Laryngoscope 2020 10 11;130(10):2319-2324. Epub 2019 Sep 11.

Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas.

Objective: To evaluate for differences in time to decannulation and survival rates for pediatric tracheotomy patients based on ventilator status upon discharge.

Study Design: Retrospective longitudinal cohort study.

Methods: A single-institution longitudinal study of pediatric tracheostomy patients was conducted. Patients were categorized based on mechanical ventilation status on discharge and principal reason for tracheostomy. Survival rates were determined using the Kaplan-Meier method. The Wilcoxon's Rank Sum test and Cox regression analysis evaluated differences in survival times and time to decannulation based on primary indication for tracheotomy and ventilation status.

Results: Chart review identified 305 patients who required a tracheostomy under the age of 3. The median age at the time of tracheotomy was 5.2 months. The indications for tracheotomy in these patients were airway obstruction in 145 (48%), respiratory failure in 214 (70%), and pulmonary toilet in 10 (3.3%). Seventy-nine percent of patients were ventilator dependent at discharge. At the conclusion of the study period, 55% of patients were alive with tracheostomy in place, 30% patients were decannulated, and 15% patients were deceased. Patients with ventilator dependence at initial discharge, bronchopulmonary dysplasia, or airway obstruction were more likely to be decannulated. Hispanic patients were less likely to be decannulated. Patients had an equal probability of death regardless of ventilator status at discharge.

Conclusions: This study demonstrated that the time to decannulation and likelihood of decannulation varies based on the indication for the tracheostomy. The majority of patients with a tracheostomy were not decannulated at the conclusion of this study. Median time to decannulation was 2.5 years for patients with a median death time of 6 months.

Level Of Evidence: 2b Laryngoscope, 130:2319-2324, 2020.
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http://dx.doi.org/10.1002/lary.28297DOI Listing
October 2020

Perioperative outcomes after tracheoplasty: A NSQIP analysis 2014-2016.

Laryngoscope 2020 06 9;130(6):1514-1519. Epub 2019 Sep 9.

Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A.

Objectives: Tracheoplasty or tracheal resection and are essential components of the care of patients with severe tracheal stenosis. We aimed to study the perioperative outcomes of patients after tracheoplasty or resection using a national surgical registry.

Methods: We analyzed the 2014 to 2016 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participant use file for patients who underwent tracheal resection or tracheoplasty (CPT codes 31750, 31760, 31780, and 31781). We analyzed the perioperative outcomes including length of stay (LOS), dehiscence, unplanned reintubations, unplanned surgeries, and 30-day readmission rates. A random 4:1 sample of non-tracheoplasty patients served as the control group.

Results: From 2014 to 2016, 126 patients underwent tracheoplasty. The median age was 56 years (IQR = 45-63). There were 93 (74%) females, 88 (70%) white, and 3.2% (4/126) Hispanic. The median LOS was 7 days (IQR = 5-10 days). Of these, 4.8% (6/126) developed wound infections and 3/126 (2.4%) developed wound dehiscence. Five out of 126 required unplanned reintubation (4.0%) and 16/126 (13%) had an unplanned reoperation. The 30-day unplanned readmission rate was 16% (20/126). The wound infection, unplanned intubations, and readmission rates were significantly higher (P < .005) than the control group.

Conclusions: The 30-day perioperative outcomes of adult patients undergoing tracheoplasty showed that adverse events are common, but severe adverse events such as death are rare. Continued research into risk mitigation among these patients is warranted.

Level Of Evidence: NA Laryngoscope, 130:1514-1519, 2020.
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June 2020

Professionalism, Quality, and Safety for Pediatric Otolaryngologists.

Otolaryngol Clin North Am 2019 Oct 5;52(5):969-980. Epub 2019 Aug 5.

Department of Otolaryngology, Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA. Electronic address:

Professionalism, quality, and safety have become essential components of pediatric otolaryngology. Professionalism, as defined by Osler, refers to the long tradition of physicians carrying out the noble cause of providing health care to patients and families. The importance of professionalism cannot be overstated and now is widely understood to be a core competency of every practicing physician. The attention to quality and safety is also a central tenet of current surgical practice. Quality is doing the right thing at the right time for the right persons. Safety is providing care to patients that is free from undue harm.
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October 2019

Asthma and obesity as predictors of severe obstructive sleep apnea in an adolescent pediatric population.

Laryngoscope 2020 03 26;130(3):812-817. Epub 2019 Apr 26.

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.

Objective: To study a cohort of children referred for full-night polysomnography (PSG) due to suspicion of obstructive sleep apnea (OSA). We examined the relationship between asthma, obesity, and severe OSA (sOSA).

Methods: We performed a retrospective case control analysis of children, ages 9 to 17 years, who underwent full-night PSG. The primary goal was to determine the association between asthma, obesity, and sOSA (apnea-hypopnea index ≥10). We used multiple logistic regression analysis to estimate these associations after controlling for covariates. A P value of ≤.05 was considered significant.

Results: The study included 367 children (mean [standard deviation] age 14 years (1.7), 56% male, 43% Hispanic). The prevalence of asthma was 188 of 367 (52%); obesity was 197 of 367 (54%); and sOSA was 109 of 367 (30%). sOSA was less likely in asthmatics (coefficient = -0.59; standard error [SE] = 0.23; P = .01; odds ratio [OR] = 0.55; 95% confidence interval [CI] = 0.34 to 0.88) and more likely with obesity (coefficient = 0.89; SE = 0.24; P < .001; OR = 2.4; 95% CI = 1.5 to 3.9). The presence of asthma reduced the likelihood of sOSA by an average of 14% among obese patients and 9% among nonobese patients. These associations held even after controlling for age, sex, race, income, and tonsillar hypertrophy.

Conclusion: The presence of asthma reduced, whereas obesity increased the likelihood of sOSA among a large cohort of older children referred for PSG. These relationships were additive. Further research is indicated regarding these relationships.

Level Of Evidence: 3b Laryngoscope, 130:812-817, 2020.
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March 2020

A Cross-sectional Analysis of Pediatric Ambulatory Tonsillectomy Surgery in the United States.

Otolaryngol Head Neck Surg 2019 10 23;161(4):699-704. Epub 2019 Apr 23.

Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Objectives: To report nationwide estimates of ambulatory tonsillectomies performed in hospitals and ambulatory surgery centers in the United States.

Study Design: Cross-sectional survey.

Setting: National databases.

Subjects And Methods: We analyzed the 2010 National Hospital Ambulatory Medical Care Survey of hospitals and ambulatory surgery centers for pediatric patients undergoing tonsillectomy with or without adenoidectomy. We determined estimations of the number of procedures, demographics, and outcomes. A tonsillectomy cohort from the 2009 National Inpatient Sample served as a comparison group.

Results: In 2010, there were an estimated 339,000 (95% CI, 288,000-391,000) ambulatory tonsillectomies in the United States. The mean age was 7.8 years (SD, 5.1), and 71,000 (21.0%) were <3 years old. The male:female ratio was even (51% vs 49%). The racial makeup mirrored the US census (69% white, 18% Hispanic, and 12% black). Obstructive sleep-disordered breathing was reported in 48%. Perioperative events such as apnea, hypoxia, or bleeding occurred 7.8% of the time. Approximately 9% of patients could not be discharged home. When compared with cases of inpatient tonsillectomies, ambulatory cases comprised older patients (7.8 vs 5.9 years, < .001) and were less likely to include obstructive sleep-disordered breathing (48% vs 77%, < .001).

Conclusion: Tonsillectomy was one of the most common ambulatory surgical procedures in 2010 in the United States. The majority of patients were low risk, but some at higher risk were included (age ≤3 years and obstructive sleep apnea). The National Hospital Ambulatory Medical Care Survey estimates provide useful baseline data for future research on quality measures and outcomes.
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October 2019

Validating peritonsillar abscess drainage rates using the Pediatric hospital information system data.

Laryngoscope 2020 01 13;130(1):238-241. Epub 2019 Feb 13.

Department of Otolaryngology-Pediatric Otolaryngology Division, UT Southwestern Medical Center and Children's Medical Center Dallas, Dallas, Texas, U.S.A.

Objectives: To evaluate the accuracy of the Children's Hospital Association's Pediatric Health Information System (PHIS) registry data in determining surgical drainage rates as compared to a chart review on the same cohort of children with diagnosis of peritonsillar abscess.

Study Design: Retrospective analysis.

Methods: Our analysis included 200 children, ages 2 to 17 years, treated for a peritonsillar abscess from 2011 to 2016. The primary outcome was to determine the sensitivity, specificity, predictive values, receiver operating characteristics (ROC), and likelihood ratios of surgical drainage rates comparing the PHIS database to manual chart review of the same patients.

Results: One hundred and fifteen (58%) children underwent drainage by chart review, whereas 87 (44%) had a drainage procedure by PHIS data. Age was a significant predictor of abscess drainage by chart review (age coefficient = 0.10; standard error = 0.04; 2 = 5.8; P = 0.02; odds ratio = 1.1; 95% confidence interval [CI] = 1.01-1.19). When using the chart review as the reference value for surgical drainage, the PHIS data had a sensitivity of 76% and 100% specificity. The positive and negative predictive values were 100% and 75%, respectively. The ROC area was 0.88 (95% CI, 84 to 92). Cases that lacked a clear procedure note composed the false negative cases in the PHIS.

Conclusion: At our institution, the PHIS Administrative data was adequate at predicting surgical drainage of the peritonsillar abscess when compared to chart review.

Level Of Evidence: 4 Laryngoscope, 130:238-241, 2020.
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http://dx.doi.org/10.1002/lary.27836DOI Listing
January 2020

Nationwide estimations of tracheal stenosis due to tracheostomies.

Laryngoscope 2019 07 19;129(7):1623-1626. Epub 2018 Dec 19.

Department of Otolaryngology, UT Southwestern Medical Center, Dallas, Texas, U.S.A.

Objectives: Tracheal stenosis is a recognized complication of tracheostomy. Yet, the incidence and demographics of tracheal stenosis due to tracheostomies have infrequently been studied.

Methods: We performed a cross-sectional analysis of U.S. emergency department (ED) visits, hospital discharges, and readmissions using the 2013 National Emergency Department Sample, 2013 National Inpatient Sample, and 2013 Nationwide Readmission Database for patients with tracheal stenosis due to tracheostomies. Also, we queried the readmission database for new tracheostomy patients who were readmitted within the same calendar year with tracheal stenosis due to the tracheostomy tube.

Results: There were an estimated 6,156 ED visits; 4,920 hospital discharges; and 2,316 readmissions for tracheal stenosis due to tracheostomies in 2013. These cases represented 28% of all tracheostomy-related complications. Of the 103,484 patients who underwent tracheostomy in 2013, 739 (1.05%) patients were readmitted within the calendar year with tracheal stenosis due to the tracheostomy tube. These stenosis patients' average age was 55 years old. Forty-five percent of the patients were female and 60% were white. The mortality rate was 7.9%. The demographic risk of stenosis mirrored the risk of tracheostomy: increasing age, male gender, and black ethnicity.

Conclusion: Tracheal stenosis due to tracheostomy was uncommon, accounting for 1% of readmissions after tracheostomies, although it represented 28% of tracheostomy-related complications and had a high mortality rate. The risk of stenosis reflected the overall tracheostomy population without apparent age, gender, or racial predilections.

Level Of Evidence: NA Laryngoscope, 129:1623-1626, 2019.
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http://dx.doi.org/10.1002/lary.27650DOI Listing
July 2019

Tracheostomy demographics and outcomes among pediatric patients ages 18 years or younger-United States 2012.

Laryngoscope 2019 07 15;129(7):1706-1711. Epub 2018 Nov 15.

Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas.

Objectives/hypothesis: To estimate the number, demographics, and outcomes of pediatric patients who underwent tracheostomy in 2012 and to contrast those outcomes by age, race, and gender.

Study Design: Cross-sectional study.

Methods: The 2012 Kids Inpatient Database was queried to identify tracheostomy patients using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedural codes 311, 3121, and 3129. All patients ≤18 years of age at the time of admission were included and categorized as neonates (≤28 days), infants (>28 days ≤1 year), toddler (1 to 3 years), children (4 to 12 years), adolescents (13 to 17 years), and adults (=18 years). We recorded age, gender, race, insurance status, and zip code of primary residence. We used these variables to contrast the following outcomes: length of stay, total charges, complications of care, and mortality using multiple regression analysis.

Results: An estimated 4,424 pediatric tracheostomies occurred during 2012. Fifty-one percent of the patients were ≤3 years old, and 62% were male. Forty-eight percentwere white followed by black (21%), Hispanic (20%), and Asian (3%). The median length of stay was 42 days, and the median total charges were $472,738. The complication rate was 29% and the mortality rate was 8.0%. The length of stay and total charges was predicted by age, with neonates having significantly longer hospitalizations. The complication rate was not associated with age, gender, or ethnicity. However, the mortality rate was associated with younger age.

Conclusions: Pediatric tracheostomies are associated with significant hospital utilizations, complications, and mortality. Increased risk of mortality is observed among neonates and infants. Continued study of tracheostomy outcomes among these subsets of the pediatric population are warranted.

Level Of Evidence: 4 Laryngoscope, 129:1706-1711, 2019.
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July 2019

Postoperative respiratory complications and racial disparities following inpatient pediatric tonsillectomy: A cross-sectional study.

Laryngoscope 2019 04 9;129(4):995-1000. Epub 2018 Nov 9.

Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.

Objectives/hypothesis: To study rates of respiratory complications/interventions among inpatient tonsillectomy patients in the United States and identify risk factors for these events.

Study Design: Retrospective database review.

Methods: Children (age < 18 years) undergoing tonsillectomy with or without adenoidectomy in 2006, 2009, and 2012 were studied using the Kids Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Outcomes were analyzed for respiratory events (complications/interventions) and racial disparities. Pearson χ test was used to analyze categorical data and regression analysis was used for continuous variables. Respiratory events were analyzed by racial identity using logistic regression analysis. A P < .05 was considered significant.

Results: The study included 30,617 patients (41% female, 51% white, 24% African American, 23% Hispanic, 3.0% Asian). The mean age was 5.2 years, and mean length of stay 2.3 days. The overall complication rate was 6.0%, and overall intervention rate was 3.6%. Respiratory events were more common among African American children (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.3-1.6) and less common among white children (OR: 0.8, 95% CI: 0.8-0.9). These differences were significant after controlling for age, gender, obesity, obstructive sleep apnea, and asthma. The mortality rate was 0.05% with no ethnic predilection.

Conclusions: Respiratory events after inpatient tonsillectomy included laryngo/bronchospasm, pneumonia, pulmonary edema, intubation, prolonged intubation, and ventilation. Although uncommon, these were more common among African American children. Further research is needed to understand the etiology of this disparity.

Level Of Evidence: NA Laryngoscope, 129:995-1000, 2019.
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April 2019

Obstructive Sleep Apnea in Children with Down Syndrome: Demographic, Clinical, and Polysomnographic Features.

Otolaryngol Head Neck Surg 2019 01 28;160(1):150-157. Epub 2018 Aug 28.

1 University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Objectives: To evaluate demographic, clinical, and polysomnographic features of children with Down syndrome suspected of having obstructive sleep apnea. To identify factors that predict severe obstructive sleep apnea among children with Down syndrome.

Study Design: Case series with chart review.

Setting: Children's Medical Center Dallas / University of Texas Southwestern Medical Center.

Subject And Methods: Demographic, clinical, and polysomnographic data were collected for children with Down syndrome aged 2 to 18 years. Simple and multivariable regression models were used to study predictors of severe obstructive sleep apnea (apnea-hypopnea index ≥10). P≤ .05 was considered significant.

Results: A total of 106 children with Down syndrome were included, with 89 (84%) <12 years old, 56 (53%) male, 72 (68%) Hispanic, 15 (14%) African American, and 14 (13%) Caucasian. Ninety percent of children had ≥1 medical comorbidities; 95 (90%) patients had obstructive sleep apnea; and 46 (44%) had severe obstructive sleep apnea. The mean SaO nadir was lower among obese than nonobese children (80% vs 85%, P = .02). Obese versus nonobese patients had a higher prevalence of severe obstructive sleep apnea (56% vs 35%, P = .03). Severe OSA was associated with heavier weight (odds ratio = 1.0, 95% CI: 1.0-1.1, P = .002) and age ≥12 years (odds ratio = 1.2, 95% CI: 0.2-2.5, P = .02). The multivariable model showed that severe obstructive sleep apnea was associated only with weight (odds ratio = 1.1, 95% CI: 1.0-1.1, P = .02).

Conclusion: Obese children with DS are at a high risk for severe OSA, with weight as the sole risk factor. The results of this study show the importance of monitoring the weight of children with DS and counseling parents of children with DS about weight loss.
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January 2019

Laryngeal stenosis among hospitalized children: Results from a nationwide cross-sectional survey.

Laryngoscope Investig Otolaryngol 2018 Jun 16;3(3):244-248. Epub 2018 Apr 16.

Department of Otolaryngology University of Maryland School of Medicine Baltimore Maryland U.S.A.

Objectives: We aimed to study laryngeal stenosis among hospitalized children in the United States from 2003-2012. We hypothesized that the prevalence of laryngeal stenosis differs by race even when controlling for age, gender, and commonly associated disease conditions.

Methods: We report the results of a cross-sectional survey of hospitalized patients with laryngeal stenosis. We utilized the Kids Inpatient Database (KID) to estimate the odds of laryngeal stenosis as a function of race using regression analysis. The effects of age, gender, and commonly associated conditions were controlled.

Results: There were 13,910 estimated discharges of patients with laryngeal stenosis (95% CI 13,715-14,105) within the study period. This accounts for 55 cases of laryngeal stenosis per 100,000 discharges (overall prevalence = 0.22%). After controlling for age and gender, Black children had the highest likelihood of laryngeal stenosis with OR of 1.9 (95% CI 1.8-2.0,  < .001) along with children classified as Other (OR = 1.2, 95% CI 1.0-1.3,  = .03). White (OR = 0.89, 95% CI 0.83-0.89,  < .001), Hispanic (OR = 0.86, 95% CI 0.80- 0.92,  < .001), and Asian (OR = 0.53, 95% CI 0.43-0.64,  < .001) children were less likely to be diagnosed with laryngeal stenosis while Native Americans (OR = 0.96, 95% CI 0.63-1.45,  = .51) were equally likely.

Conclusions: Laryngeal stenosis is more common among hospitalized Black children, while other racial groups appear to have lower risk. This elevated risk remained when controlling for age, gender, and commonly associated conditions with laryngeal stenosis.

Level Of Evidence: 4.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057228PMC
June 2018

Nationwide readmissions after tonsillectomy among pediatric patients - United States.

Int J Pediatr Otorhinolaryngol 2018 Apr 20;107:10-13. Epub 2018 Feb 20.

UT Southwestern Medical Center Dallas, Dallas, TX, USA; Children's Medical Center Dallas, Children's Health, Dallas, TX, USA.

Objectives: 1) Investigate incidence and predictors of readmissions after tonsillectomy with or without adenoidectomy (T&A) in children. 2) Identify factors that may predict readmission.

Settings: Nationwide cross-sectional survey of US hospital admissions.

Subjects: and Methods: The 2013 Nationwide Readmission Database (NRD) was used to examine all-cause readmissions within 30 days of T&A in children (age <18 years). Logistic regression was used to analyze the associations of demographics, diagnosis, insurance status, length of index stay, and median household income with readmission.

Results: 9079 children undergoing T&A resulted in 327 (3.6%) patients requiring readmission. The average age of children readmitted were 5.0 years and they were 51% female. The most common readmission diagnoses were dehydration (47%), hemorrhage (26%), and pain (16%). The average time to readmission was 7.3 days. The average times to readmission for hemorrhage, pain and dehydration were 6.3, 4.5 and 4.1 days, respectively. Children who needed respiratory intubation (OR = 4.0), had a medical or surgical complication (OR = 3.3), or prolonged hospital stay (OR = 1.03) during the index admission were more likely to be readmitted. Age, gender, payer and socioeconomic status and diagnosis of obstructive sleep apnea (OSA) did not increase the odds of readmission.

Conclusions: Readmissions in children after T&A were primarily due to dehydration, hemorrhage, and pain. Adequate symptom control in children has the greatest potential to reduce readmission rates following T&A.
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April 2018

Emergency department visits, hospitalizations, and readmissions of patients with a peritonsillar abscess.

Laryngoscope 2017 10 7;127 Suppl 5:S1-S9. Epub 2017 Aug 7.

Department of Otolaryngology and Pediatric Otolaryngology, UT Southwestern Medical Center at Dallas and Children's Medical Center Dallas, Dallas, Texas, U.S.A.

Objectives: To determine the demographics and treatment outcomes of patients with a peritonsillar abscess (PTA) and to provide guidance for treatment options.

Methods: The 2012 National Emergency Department Database, 2012 National Inpatient Sample, and 2013 Nationwide Readmissions Database were used to analyze patients with a PTA who presented to emergency departments (ED), were admitted and/or readmitted to hospitals in the United States. Outcomes were used to create a decision model to compare initial medical versus surgical management.

Results: An estimated 62,787 ED visits; 15,095 inpatient admissions; and 267 readmissions for PTA were recorded. The average age was 29 years old, with a slight male predominance. The majority of patients seen in the ED (80%) were treated without surgery and discharged home. Patients admitted to hospital were more likely to undergo surgery (50%). The tonsillectomy rate was 11%. The complication and readmission rates were < 2%. Medical therapy was used more often than surgical therapy in many cases.

Conclusion: Peritonsillar abscess mostly occurs in adults and leads to a significant number of ED visits, admissions, and readmissions. A trial of medical management of PTA appears to be safe, although surgery is highly successful and associated with low morbidity.

Level Of Evidence: 2c. Laryngoscope, 127:S1-S9, 2017.
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http://dx.doi.org/10.1002/lary.26777DOI Listing
October 2017