Classification System Score Research Articles

Effectiveness of the advisory display SmartPilot\xae view in the assessment of anesthetic depth in low risk gynecological surgery patients: a randomized controlled trial

BackgroundAssessment of appropriate anesthetic depth is crucial to prevent harm to patients. Unnecessary deep anesthesia can be harmful, potentially causing acute renal failure, myocardial injury, delirium, and an increased mortality rate. Conversely, too light anesthesia combined with muscle relaxants can result in intraoperative patient awareness and lead to serious psychological trauma. This trial aimed to ascertain the effectiveness of the advisory display SmartPilot® View (SPV), as a supplemental measure in the assessment of anesthetic depth in low risk gynecological surgery patients. The hypothesis was that the use of the SPV would increase the precision of assessment, and result in a higher mean arterial pressure.MethodsThis trial used a randomized, controlled, single-blind design with a homogeneous sample. Patients undergoing minor, low risk gynecological surgery were randomly assigned to two groups: a test group wherein current standards were supplemented with the advisory display SPV and a control group assessed using only the current standards. Female patients aged between 18 and 75 years with American Society of Anesthesiologists Physical Status Classification System scores of 1–3 undergoing planned general anesthesia using the total intravenous anesthetic method, combining propofol and remifentanil, were included. The exclusion criteria included a body mass index ≥ 35 kg/m2, a history of alcoholism, drug intake affecting propofol and remifentanil dynamics, and inability to consent. The independent sample t-test and chi-square test or Fisher’s exact test were used to assess the statistical significance of differences between the two groups.ResultsA total of 114 patients were included in the analysis (test group n = 58, control group n = 56). No significant differences in the mean arterial pressure, heart rate, bispectral index, extubation delay, or post-anesthesia care unit stay were found between groups.ConclusionsThe addition of the advisory display SmartPilot® View to current standards in the evaluation of anesthetic depth had no significant effect on the outcome.Trial registrationThe trial was registered on January 16th 2019 with ClinicalTrials.gov (ref: NCT03807271).

Accuracy of MRI (TLICS vs AOSIS) in assessment of thoracolumbar spine injuries for guiding treatment

BackgroundThe thoracic segment represents the most common area fractured in the whole spine. Complete neurological deficits are commonly associated with thoracic injuries possibly due to a relatively small canal diameter as compared to the cervical or lumbar spine. Magnetic resonance is the gold standard of imaging, especially in patients suffering from neurological deficits as well as in soft tissue assessment mainly the disc, ligaments, and neural elements. The thoracolumbar injury classification and severity score system (TLICS) and the thoracolumbar AO Spine injury score (TLAOSIS), are two scoring systems designed to help surgeons in management plans of thoraco-lumbar injuries. The aim of our study is to compare these two main thoracolumbar injury classification systems in deciding the management strategies in thoraco-lumbar injuries. This study is a retrospective study that included 70 patients (42 males and 28 females) who suffered acute traumatic vertebral fractures. All patients underwent MRI including T1WI, T2W and STIR sequences. The MRI was viewed by two independent radiologists of 5- and 10-years’ experience and compared to surgical decisions.ResultsOut of 70 patients included in our study, the TL AOSIS matched treatment recommendation in 62 patients (88.6%), and the TLICS matched in 60 patients (85.7%). The TL AOSIS achieved sensitivity 95%, specificity 80%, while the TLICS achieved sensitivity 72.2%, specificity 100%.ConclusionBoth TL AOSIS and TLICS have very close results in their reliability for guiding treatment strategy, yet TL AOSIS matched treatment recommendation more than TLICS, with sensitivity more than TLICS, while TLICS had more specificity.

In Reply to the Letter to the Editor Regarding “Retrospective Evaluation of Thoracolumbar Injury Classification System and Thoracolumbar AO Spine Injury Scores for the Decision Treatment of Thoracolumbar Traumatic Fractures in 458 Consecutive Patients”

In Reply to the Letter to the Editor Regarding “Retrospective Evaluation of Thoracolumbar Injury Classification System and Thoracolumbar AO Spine Injury Scores for the Decision Treatment of Thoracolumbar Traumatic Fractures in 458 Consecutive Patients”

Letter to the Editor Regarding “Retrospective Evaluation of Thoracolumbar Injury Classification System and Thoracolumbar AO Spine Injury Scores for the Decision Treatment of Thoracolumbar Traumatic Fractures in 458 Consecutive Patients”

Letter to the Editor Regarding “Retrospective Evaluation of Thoracolumbar Injury Classification System and Thoracolumbar AO Spine Injury Scores for the Decision Treatment of Thoracolumbar Traumatic Fractures in 458 Consecutive Patients”

Coordinated State Analysis and Differential Regulation of Territorial Spatial Functions in Underdeveloped Regions: A Case Study of Gansu Province, China

The coordinated development of territorial spatial functions is the main manifestation of the sustainable utilization of territorial resources. Identifying spatial functions and their coordinated relationship has become an important guarantee for regional coordinated development, and is of great significance to the construction of a sustainable land development and protection pattern. This study constructs a classification and function scoring system for Production-Living-Ecological Spaces (PLES) by using land-use data from Gansu Province in 2000 and 2020, and revises the spatial functions of the land to supplement the deficiencies of existing related researches by combining socio-economic data (GDP, population density) and ecosystem service value data. In the aforementioned works, the Mechanical Equilibrium Model in physics is referenced to explore the coordinated state among territorial spatial functions. The results show that the high-value areas of production function are mainly distributed in the eastern and central areas of the Loess Plateau, with a strip-like distribution in the Hexi Corridor. The high-value areas of living function are consistent with that in the center of the city. The distribution of high-value areas of ecological function is in line with the topographic distribution pattern of mountainous areas in Gansu Province. The distribution pattern of the coordinated state of land space function in Gansu Province is relatively stable from 2000 to 2020. Simultaneously, the functional dominant area and the promotion area are identified according to the deviation of the coordinated degree of production-living-ecological function. After clarifying the functional characteristics of each county, the author proposes a differentiated regulation strategy of territorial spatial function.

The relationship between death risk and nutritional factors in individuals with acute coronary syndrome

There is a relationship between low food intake and risk of death in patients with acute coronary syndrome. In this study aimed to examine the relationship between The Global Registry of Acute Coronary Events (GRACE risk score) and food intake.: 140 men over 35 years of age with Acute Coronary Syndrome were included in the study. The 1-day energy and nutrient consumption of individuals was determined using a 24-hour food consumption recording method. Based on the GRACE risk score classification system, the patients were divided into four quartiles (89.5≥Q1≥72, 102.5≥Q2≥89.5, 117.75≥Q3≥102.51, 152≥Q4≥117.76). The macro and micronutrient intakes of individuals were compared between the four groups. Nutrient intake decreased in the group with the highest grace risk score. inadequate nutrient intake further increased the GRACE risk score. A negative correlation was found between the GRACE risk score and macro and micronutrients (p<0.05). We found that the increase in the GRACE risk score decreased the food intake otherwise a low level of food intake increased the risk of death.

P.0132 Selective lesions of medial septal cholinergic and gabaergic neurons differentially affect spatial memory and various neurotransmitter markers in the hippocampus

To investigate the characteristics of oropharyngeal dysphagia in adults with dyskinetic cerebral palsy (DCP) and cervical dystonia (CD).Exploratory observational cross-sectional study.University hospital.Seventeen patients with DCP (8 men, 9 women; age, 45.7±6.3y) enrolled in a randomized controlled trial on the effects of botulinum toxin injection on CD.Not applicable.Baseline clinical assessments and videofluoroscopic swallowing studies (VFSSs) were conducted. VFSS findings were evaluated using the videofluoroscopic dysphagia scale (VDS) and the penetration-aspiration scale (PAS). The Gross Motor Function Classification System (GMFCS) and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were also assessed. Relationships between outcomes were evaluated using Spearman’s rank correlation.The clinical assessment revealed abnormalities in chewing (n=10, 58.8%), tongue movement (n=10, 58.8%), and laryngeal elevation (n=8, 47.1%). The most common abnormality on the VDS was inadequate mastication (n=13, 76.5%), followed by premature bolus loss, vallecular residue, and penetration/aspiration (all: n=10, 58.8%). A maximum PAS score of 8 was observed in 8 of 17 patients (47.1%). Total and pharyngeal VDS scores were significantly correlated with TWSTRS scores (ρ=0.543, P=.024 and ρ=0.539, P=.026, respectively); the VDS oral score did not correlate with the TWSTRS score (ρ=0.446, P=.073). There was no significant correlation between VDS score and GMFCS level (ρ=0.212, P=.414).This preliminary observational study presents the characteristics of oropharyngeal dysphagia in adults with DCP and CD. Pharyngeal stage difficulties were negatively correlated with severity of CD, but not with GMFCS level. Screening for dysphagia may be recommended in adults with DCP and severe CD.

P116 “KIGNSNORTH MODIFIED SCORE” FOR OPEN INGUINAL HERNIA REPAIR COMPLICATIONS PREDICTION. POINTHER STUDY

Abstract Aim Aim of our study is to analysis of postoperative outcomes (30 days) after elective unilateral open anterior inguinal hernia repair and prove correlation to modified Kingsnorth (MK) score classification system. Material and Methods Prospective registered (NTC 04806828) study of all consecutive unilateral open anterior groin hernia repair performed at a University Hospital General Surgery Department from January 2019 to December 2020. Data was stored at National Spanish Groin Hernia Registry (EVEREG). All patients were preoperatively classified using MK score. Statistical analysis of postoperative complications and their relation to preoperative modified Kingsnorth scale was performed. Results 403 patients were included. 61% were performed as ambulatory surgery. 15.7% had more than 5-8 MK punctuation. A total of 62 patients had postoperative complications, 81% of all complications were classified as Clavien I. Higher Surgery duration was directly related to higher MK (Pearson's correlation 0.291; P < 0.0001score.) Statistically significant relationship with the presence of higher rate of complications were a KN score of 5-8 (OR 2.7; 95% CI 1.07-4.82; P = 0.03) whereas performance of surgery by an abdominal wall surgery specialist had less complications (OR 0.28; 95% CI 0.08-0.92; P = 0.03) Conclusions MK classification predicts surgical wound complications on patients who undergo a primary unilateral inguinal hernia surgery. A KN score of 5-8 had a higher probability of wound complications. When surgery was performed by a specialist in abdominal wall surgery, less postoperative complications were observed.

Late onset of type 2 diabetes is associated with mitochondrial tRNATrp A5514G and tRNASer(AGY) C12237T mutations.

BackgroundMitochondrial dysfunctions caused by mitochondrial DNA (mtDNA) pathogenic mutations play putative roles in type 2 diabetes mellitus (T2DM) progression. But the underlying mechanism remains poorly understood.MethodsA large Chinese family with maternally inherited diabetes and deafness (MIDD) underwent clinical, genetic, and molecular assessment. PCR and sequence analysis are carried out to detect mtDNA variants in affected family members, in addition, phylogenetic conservation analysis, haplogroup classification, and pathogenicity scoring system are performed. Moreover, the GJB2, GJB3, GJB6, and TRMU genes mutations are screened by PCR‐Sanger sequencing.ResultsSix of 18 matrilineal subjects manifested different clinical phenotypes of diabetes. The average age at onset of diabetic patients is 52 years. Screening for the entire mitochondrial genomes suggests the co‐existence of two possibly pathogenic mutations: tRNATrp A5514G and tRNASer(AGY) C12237T, which belongs to East Asia haplogroup G2a. By molecular level, m.A5514G mutation resides at acceptor stem of tRNATrp (position 3), which is critical for steady‐state level of tRNATrp. Conversely, m.C12237T mutation occurs in the variable region of tRNASer(AGY) (position 31), which creates a novel base‐pairing (11A‐31T). Thus, the mitochondrial dysfunctions caused by tRNATrp A5514G and tRNASer(AGY) C12237T mutations, may be associated with T2DM in this pedigree. But we do not find any functional mutations in those nuclear genes.ConclusionOur findings suggest that m.A5514G and m.C12337T mutations are associated with T2DM, screening for mt‐tRNA mutations is useful for molecular diagnosis and prevention of mitochondrial diabetes.

Can extant comorbidity indices identify patients who experience poor outcomes following total joint arthroplasty?

It is uncertain if generic comorbidity indices commonly used in orthopedics accurately predict outcomes after total hip (THA) or knee arthroplasty (TKA). The purpose of this study was to determine the predictive ability of such comorbidity indices for: (1) 30-day mortality; (2) 30-day rate of major and minor complications; (3) discharge disposition; and (4) extended length of stay (LOS). The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent elective THA (n = 202,488) or TKA (n = 230,823) from 2011 to 2019. The American Society of Anesthesiologists (ASA) physical status classification system score, modified Charlson Comorbidity Index (mCCI), Elixhauser Comorbidity Measure (ECM), and 5-Factor Modified Frailty Index (mFI-5) were calculated for each patient. Logistic regression models predicting 30-day mortality, discharge disposition, LOS greater than 1 day, and 30-day major and minor complications were fit for each index. The ASA classification (C-statistic = 0.773 for THA and TKA) and mCCI (THA: c-statistic = 0.781; TKA: C-statistic = 0.771) were good models for predicting 30-day mortality. However, ASA and mCCI were not predictive of major and minor complications, discharge disposition, or LOS. The ECM and mFI-5 did not reliably predict any outcomes of interest. ASA and mCCI are good models for predicting 30-day mortality after THA and TKA. However, similar to ECM and mFI-5, these generic comorbidity risk-assessment tools do not adequately predict 30-day postoperative outcomes or in-hospital metrics. This highlights the need for an updated, data-driven approach for standardized comorbidity reporting and risk assessment in arthroplasty.

How Should Patients with a Thoracolumbar Injury Classification and Severity Score of 4 Be Treated?

The thoracolumbar injury classification and severity score (TLICS) system help surgeons decide whether patients should undergo initial operative treatment or nonoperative treatment. However, the best treatment for patients with TLICS 4 fracture remains unknown. The aim of this study was to identify the risk factors for nonoperative treatment failure in patients with TLICS 4 fracture and establish treatment standards for TLICS 4 fractures. This study included 44 patients with TLICS 4 fracture who initially received nonoperative treatment. We divided these patients into two groups: the successful nonoperative treatment group included 18 patients, and the operative treatment group after nonoperative treatment failure included 26 patients. In multiple logistic regression analysis, spinal canal compromise (odd ratio = 1.316) and kyphotic angle (odd ratio = 1.416) were associated with nonoperative treatment failure in patients with TLICS 4 fracture. Other factors, including age, sex, BMI, initial VAS score, and loss of vertebral body height, were not significantly associated with nonoperative treatment failure in these patients. Spinal canal compromise and kyphotic angle were associated with nonoperative treatment failure in patients with TLICS 4 fracture. Therefore, we recommend the surgeon observe spinal canal compromise and kyphotic angle more carefully when deciding on the treatment of patients with TLICS 4 fracture.

A quantitative polymerase chain reaction based method for molecular subtype classification of urinary bladder cancer-Stromal gene expressions show higher prognostic values than intrinsic tumor genes.

Transcriptome-based molecular subtypes of muscle-invasive bladder cancer (MIBC) have been shown to be both prognostic and predictive, but are not used in routine clinical practice. We aimed to develop a feasible, reverse transcription quantitative polymerase chain reaction (RT-qPCR)-based method for molecular subtyping. First, we defined a 68-gene set covering tumor intrinsic (luminal, basal, squamous, neuronal, epithelial-to-mesenchymal, in situ carcinoma) and stromal (immune, extracellular matrix, p53-like) signatures. Then, classifier methods with this 68-gene panel were developed in silico and validated on public data sets with available subtype class information (MD Anderson [MDA], The Cancer Genome Atlas [TCGA], Lund, Consensus). Finally, expression of the selected 68 genes was determined in 104 frozen tissue samples of our MIBC cohort by RT-qPCR using the TaqMan Array Card platform and samples were classified by our newly developed classifiers. The prognostic value of each subtype classification system and molecular signature scores were assessed. We found that the reduced marker set combined with the developed classifiers were able to reproduce the TCGA II, MDA, Lund and Consensus subtype classification systems with an overlap of 79%, 76%, 69% and 64%, respectively. Importantly, we could successfully classify 96% (100/104) of our MIBC samples by using RT-qPCR. Neuronal and luminal subtypes and low stromal gene expressions were associated with poor survival. In conclusion, we developed a robust and feasible method for the molecular subtyping according to the TCGA II, MDA, Lund and Consensus classifications. Our results suggest that stromal signatures have a superior prognostic value compared to tumor intrinsic signatures and therefore underline the importance of tumor-stroma interaction during the progression of MIBC.

Incidence of and Risk Factors for Postoperative Venous Thromboembolism in Benign Hysterectomy

Describe the incidence of and risk factors associated with postoperative venous thromboembolism (VTE) in patients undergoing hysterectomy for benign indications with emphasis on the impact of route of surgery. Retrospective cohort. National Surgical Quality Improvement Project Database. Data of women aged 18 years and older who underwent hysterectomy for benign indications between 2014 and 2018 were abstracted. Cases were identified by Current Procedural Terminology codes and International Classification of Diseases codes. Patient demographics, preoperative comorbidities, American Society of Anesthesiologists (ASA) classification system scores, total operating time, length of stay, readmission, reoperation, VTE including deep vein thrombosis and pulmonary embolism were collected. Cases were stratified by route of hysterectomy. t test and multivariable logistic regression were used for analysis. A total of 94 940 patients underwent hysterectomy, of which 23 081 (24.3%) underwent abdominal hysterectomy, 56 656 (59.7 %) laparoscopic hysterectomy, and 15 203 (16.0%) vaginal hysterectomy. The overall incidence of VTE was 0.4%. The incidence of VTE was higher for abdominal (0.7%), than laparoscopic (0.3%, p <.001), and vaginal hysterectomy (0.2%, p <.001). Higher ASA classification was independently associated with postoperative VTE. Age, race, body mass index, uterine weight, operative time, multiple medical comorbidities, and smoking status were not independently associated with increased risk of VTE. Postoperative VTE after hysterectomy for benign indications is rare. The risk of postoperative VTE is higher in patients undergoing abdominal hysterectomy compared with minimally invasive hysterectomy including laparoscopic and vaginal routes of surgery. In addition, the risk of VTE may be higher with higher ASA class.

S2k guideline: Diagnosis and management of cutaneous lupus erythematosus - Part1: Classification, diagnosis, prevention, activity scores.

S2k guideline: Diagnosis and management of cutaneous lupus erythematosus - Part1: Classification, diagnosis, prevention, activity scores.

Does a Prescription-based Comorbidity Index Correlate with the American Society of Anesthesiologists Physical Status Score and Mortality After Joint Arthroplasty? A Registry Study.

When analyzing the outcomes of joint arthroplasty, an important factor to consider is patient comorbidities. The presence of multiple comorbidities has been associated with longer hospital stays, more postoperative complications, and increased mortality. The American Society of Anesthesiologists (ASA) physical status classification system score is a measure of a patient's overall health and has been shown to be associated with complications and mortality after joint arthroplasty. The Rx-Risk score is another measure for determining the number of different health conditions for which an individual is treated, with a possible score ranging from 0 to 47. For patients undergoing THA or TKA, we asked: (1) Which metric, the Rx-Risk score or the ASA score, correlates more closely with 30- and 90-day mortality after TKA or THA? (2) Is the Rx-Risk score correlated with the ASA score? This was a retrospective analysis of the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) database linked to two other national databases, the National Death Index (NDI) database and the Pharmaceutical Benefits Scheme (PBS), a dispensing database. Linkage to the NDI provided outcome information on patient death, including the fact of and date of death. Linkage to the PBS was performed to obtain records of all medicines dispensed to patients undergoing a joint replacement procedure. Patients were included if they had undergone either a THA (119,076 patients, 131,336 procedures) or TKA (182,445 patients, 215,712 procedures) with a primary diagnosis of osteoarthritis, performed between 2013 and 2017. We excluded patients with missing ASA information (THA: 3% [3055 of 119,076]; TKA: 2% [4095 of 182,445]). This left 127,761 primary THA procedures performed in 116,021 patients (53% [68,037 of 127,761] were women, mean age 68 ± 11 years) and 210,501 TKA procedures performed in 178,350 patients (56% [117,337 of 210,501] were women, mean age 68 ± 9 years) included in this study. Logistic regression models were used to determine the concordance of the ASA and Rx-Risk scores and 30-day and 90-day postoperative mortality. The Spearman correlation coefficient (r) was used to estimate the correlation between the ASA score and Rx-Risk score. All analyses were performed separately for THAs and TKAs. We found both the ASA and Rx-Risk scores had high concordance with 30-day mortality after THA (ASA: c-statistic 0.83 [95% CI 0.79 to 0.86]; Rx-Risk: c-statistic 0.82 [95% CI 0.79 to 0.86]) and TKA (ASA: c-statistic 0.73 [95% CI 0.69 to 0.78]; Rx-Risk: c-statistic 0.74 [95% CI 0.70 to 0.79]). Although both scores were strongly associated with death, their correlation was moderate for patients undergoing THA (r = 0.45) and weak for TKA (r = 0.38). However, the median Rx-Risk score did increase with increasing ASA score. For example, for THAs, the median Rx-Risk score was 1, 3, 5, and 7 for ASA scores 1, 2, 3, and 4, respectively. For TKAs, the median Rx-Risk score was 2, 4, 5, and 7 for ASA scores 1, 2, 3, and 4, respectively. The ASA physical status and RxRisk were associated with 30-day and 90-day mortality; however, the scores were only weakly to moderately correlated with each other. This suggests that although both scores capture a similar level of patient illness, each score may be capturing different aspects of health. The Rx-Risk may be used as a complementary measure to the ASA score. Level III, therapeutic study.

Retrospective Evaluation of Thoracolumbar Injury Classification System and Thoracolumbar AO Spine Injury Scores for the Decision Treatment of Thoracolumbar Traumatic Fractures in 458 Consecutive Patients

Thoracolumbar Injury Classification System (TLICS) score and Thoracolumbar AO Spine Injury Score (TLAOSIS) are the scores preferred to classify and treat thoracolumbar fractures. Our study evaluates the reliability of both as guidelines for treatment. Single-center and retrospective case series of 458 patients. Clinical variables, radiology, and treatment were analyzed. We classified fractures according to the AO Spine Thoracolumbar System and retrospectively applied both scales in 2 groups (surgical and conservative). A concordance analysis and statistical measures comparing both were performed. The patients were divided as follows: 257 patients (56.1%) in the conservative group and 201 patients (43.9%) in the surgical group. The concordance analysis between both scales was 89.7% (95% confidence interval, 86.5%-92.3%), and the Cohen kappa coefficient was 0.68 (95% confidence interval, 59%-76%). TLAOSIS had a higher tendency to classify patients in the gray zone (10.3% vs. 2.8%, P < 0.001), whereas TLICS had a more conservative nature (85.2% vs. 78.4%, P= 0.01). In the surgical group, the matching decision ratio was 29.9% for TLICS and 42.8% for TLAOSIS, but differences were found in TLICS being more conservative (70.1% vs. 57.2%, P= 0.01). In the conservative group, the matching decision ratio was 98.1% for both scales, being the main difference in the gray zone for TLAOSIS. Both scales have a good concordance in general, with TLICS being more conservative overall. They had rather low coincidence when predicting surgery. Because TLAOSIS placed more patients in the gray zone, we think it might be slightly better for giving surgeons more license to decide a surgical approach on certain controversial types of fractures.

Increased prevalence of Stroke Recurrence and Stroke Related Mortality in Children with Sickle Cell Disease in Nigeria: evidence for a Secondary Stroke Prevention Trial.

Introduction- Nigeria has the highest burden of sickle cell anemia (SCA) in the world accounting for 50% of the 300,000 SCA births globally. In a recent survey conducted locally in Nigeria, Kano state was shown to have the highest number of children with SCA in Nigeria, with Kano metropolitan city alone having over 15,000 children with SCA. Stroke is one of the most devastating yet preventable complications in children with SCA. Without transcranial Doppler (TCD) screening and treatment, approximately 7 to 10% of the children with SCA will develop strokes. Among untreated children with strokes, there is at least a 50% recurrence rate after 2 years. Due to the high rate of stroke recurrence and the absence of regular blood transfusion therapy as a viable option due to availability, poor parental acceptance of blood transfusion, and cost, hydroxyurea therapy is the only viable option for the majority of children. However, the benefit and risks of hydroxyurea for secondary stroke prevention is poorly defined in Nigeria.Methodology- In preparation for a phase III trial of hydroxyurea for secondary stroke prevention in children with SCA in sub-Saharan Africa, we initiated a standard care protocol in 2014 to manage children with strokes at Aminu Kano Teaching Hospital Kano, Nigeria, to determine the prevalence of stroke among children with SCA between Jan 2014 to May 2017. Ethical approval to conduct the study was received from the ethics committee of Aminu Kano Teaching hospital in Kano, Nigeria.Result-We identified 29 children with SCA who had an initial stroke within the study period, with 7 children having >1 stroke, and a mortality rate of 6.9% (2/29). Death was unrelated to any toxicity associated with hydroxyurea. None of the children treated with hydroxyurea, had therapy held because of myelosuppression or anemia. The rate of initial stroke in the pediatric clinic population of approximately 500 children (age birth through 12 years) over a three-year period was 1.97 per 100 patient-years. The median age for the first stroke was 5.6 years (range 1.1 to 14.2 years). Children with initial strokes were followed for a total of 38.8 years and had a rate of recurrence of 18.1 events per 100 patient-years, (figure 1) significantly below the expected rate of 29 events per 100 patient years if no treatment was offered, but a significantly higher incidence rate compared to regular blood transfusion of 1.9 events per patient year. Of the patients with an initial stroke, 65.5% received an exchange transfusion and 92.6% were either already on hydroxyurea (n=1) or started on fixed dose hydroxyurea (n=24), 20 mg/kg/day, within 2 months of the stroke, as part of standard care. The median modified Rankin was 1 with a range from 0 to 6, on the gross motor function classification system score. 10 children (40.0%) had normal function and 6 (24.0%) had level III or higher. Both measurements were completed at a median of 1.6 years (IQR 1.9 years) after the initial stroke. (Table I)Conclusion-Our results provide strong evidence for the high prevalence of stroke and death following a stroke in children with SCA in Nigeria. Optimal hydroxyurea dose for secondary stroke prevention is unknown in low-resource setting. Given the prevalence of strokes in unscreened and untreated children with SCA, primary and secondary stroke prevention program are a public urgency in children with SCA living in Nigeria. We are currently conducting a randomized controlled trial for secondary prevention of strokes comparing fixed dose of 20 mg/kg/day vs 10 mg/kg/day (NCT NCT01801423). [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Videofluoroscopic Swallow Study Findings and Correlations in Infancy of Children with Cerebral Palsy.

Cerebral palsy (CP) in infants can affect global motor function and lead to swallowing difficulties. This study aims to characterize oral and pharyngeal swallowing dynamics in infancy of patients later diagnosed with CP and to determine if swallow study performance in early infancy is associated with later CP severity and characteristics. This is a retrospective chart review of infants who underwent videofluoroscopic swallow studies (VFSS) between 6/2008 and 10/2018 at a tertiary children's hospital, and were later diagnosed with CP. Demographic data, CP characteristics and metrics, and VFSS findings were collected and analyzed. There were 66 patients included in this study. The average age at the time of VFSS was 4 months (range: 0.3-12 months), 42% of patients were female, and 50% of patients were born premature. In our sample, 86% of patients presented with oral dysphagia, and 76% with pharyngeal dysphagia. Laryngeal penetration in isolation was seen in 39% of patients, and tracheal aspiration was seen in 38% of patients. Of these tracheal aspiration events, 64% were silent. At the time of VFSS, 58% of patients had a nasogastric tube, 12% had a gastrostomy tube, and 3% had a prior hospitalization for pneumonia. Rates of penetration and aspiration in early infancy did not consistently correlate with prematurity, type of CP (spastic, non-spastic, or mixed), degree of paralysis (quadriplegic, hemiplegic, or diplegic), or severity of Gross Motor Function Classification System (GMFCS) score. While there was not a consistent correlation of swallowing dynamics in infancy with later gross motor categorizations of CP, the results of this retrospective review highlight the essential role of early clinical and videofluoroscopic swallowing evaluations to identify oral and pharyngeal swallowing dysfunction in this patient population.

MO533WHICH PARAMETERS BEST PREDICT POSITIVE COVID-19 STATUS FOLLOWING HIP FRACTURE FOR PATIENTS LIVING WITH CKD?

Background and AimsPatients living with chronic kidney disease (CKD) are at greater susceptibility of sustaining hip fractures compared to those without CKD due to higher falls risk. Post-trauma clinical outcomes for patients living with CKD are exacerbated by frailty, co-morbidities and sarcopenia. Patients living with CKD may require lengthy hospitalization following hip fracture, considering the additional indications for extensive treatment and rehabilitation. A long hospital stay may bring greater risks of contracting COVID-19, given the magnitude of this current global pandemic. Complications from COVID-19 significantly increase mortality risks for older patients living with CKD after acute trauma, as a considerable proportion will have a poor baseline health and functional status. Our study aims to determine the most useful clinical and laboratory assessment tools to predict for a positive COVID-19 status following hospitalization with hip fracture in patients living with CKD.MethodPatients with CKDG3b-5 admitted from home to a tertiary hospital in North West UK with hip fracture between Feb and Dec 2020 were included. Each patient included in this study received at least one COVID-19 nasopharyngeal swab during their hospitalization. Parameters assessed on hospital admission for each patient included Clinical Frailty Scale (CFS), Charlson’s Co-morbidity Index (CCI), Chronic Kidney Disease Frailty Index Laboratory Score (CKD FI-LAB), Estimated VO2 Peak, Karnofsky Performance Status Scale, Sernbo Score, Nottingham Hip Fracture Score, ASA Physical Status Classification System Score and Abbreviated Mental Test Score. Receiver Operating Characteristic (ROC) curve analyses were performed to evaluate the ability of individual parameters to predict for a positive COVID-19 status following hip fracture in patients living with CKD. Events of 30-day mortality were recorded.Results92 patients met study inclusion criteria. The mean age was 84.6±7.8 years and the female:male ratio was 1.6:1. 7 patients (7.6%) were on long-term dialysis and the mean eGFR amongst non-dialysis patients was 36.5±13.8 ml/min/1.73m2. The median length of hospitalization was 17 days. 22 patients (23.9%) tested positive for COVID-19. Area under a Curve (AUC) values from ROC analyses are shown in Table 1. The difference in 30-day mortality rate between patients who tested positive for COVID-19 and those who tested negative was +6.8% (p<0.001).ConclusionFrailty and co-morbidity assessment tools (CFS, CCI and CKD FI-LAB) displayed the best predictive ability for positive COVID-19 status following hip fracture in patients living with CKD. A continuous, holistic multi-disciplinary team approach during hospitalization for comprehensive geriatric assessment and optimization of medical co-morbidities may improve outcomes, in anticipation of a potential lengthy hospital stay. To improve prognosis, research efforts should continue to explore avenues on reducing COVID-19 rates within this patient population.MO533 Table 1:AUC values to predict for positive COVID-19 status following hip fracture in patients living with CKDPredictorAUC Value95% ClClinical Frailty Scale0.940.87-1.00Charlson’s Co-morbidity Index0.920.86-0.99Chronic Kidney Disease Frailty Index Laboratory Score0.880.81-0.95Estimated VO2 Peak0.860.79-0.92Karnofsky Performance Status Scale0.840.77-0.91Sernbo Score0.800.74-0.87Nottingham Hip Fracture Score0.770.70-0.84ASA Physical Status Classification System Score0.740.67-0.81Abbreviated Mental Test Score0.650.58-0.72

Add-on Home-Centered Activity-Based Therapy vs Conventional Physiotherapy in Improving Walking Ability at 6-Months in Children With Diplegic Cerebral Palsy: A Randomized Controlled Trial

: Institutional physiotherapy as a standard of care for management of cerebral palsy (CP) has certain shortcomings, especially in resource-constrained settings. This is a proof-of-concept trial to evaluate the efficacy of individualized home-centered activity-based therapy in children with spastic diplegic CP. Randomized controlled trial (open-label). Tertiary-care hospital with pediatric neurology services (July, 2014 to July, 2016). Consecutive sample of 59 children (5-12 y) with spastic diplegic CP (Gross Motor Function Classification System scores II-III) without fixed lower-limb contractures, illnesses impeding physiotherapy or history of recent botulinum toxin injection/surgery were recruited. Children were randomized to Intervention or Control arms. Their 6-minute-walk Test (6MWT) scoring and clinical examination were performed at baseline, 3 and 6 months. Children in Intervention arm (n=30) were prescribed parent-supervised home-centered activity-based therapy (walking, standing, squatting, climbing upstairs/downstairs, kicking a ball, dancing, riding a tricycle/bicycle) in addition to their institutional physiotherapy. Children in Control arm (n=29) were prescribed ongoing institutional physiotherapy alone. Logbooks, home videos and telephonic follow-ups were used to ensure compliance. Comparison of the mean change in 6MWT scores at 6 months (from baseline) between the two groups. Median (IQR) change in 6MWT scores at 6 months (from baseline) in the Intervention and Control arms were 3.5 (-5.3, 9) m and 3 (-7.8, 6.3) m. Adjunct home-centered activity-based therapy was safe and feasible, but did not result in appreciable gains over 6 months.