88 Infant malrotation with midgut volvulus: A prospective analysis of a new clinical pathway for management of patients presenting with bilious vomiting
Notice bibliographique
Résumé
Abstract Background Bilious vomiting (BV) is a hallmark warning sign of malrotation with midgut volvulus (MV), a potentially life-threatening condition in infants that requires immediate intervention. A retrospective analysis of MV cases (2015–2022) at our tertiary paediatric center (epoch 1) revealed substantial delays in management, which prompted this study. Objectives The primary objective of this quality improvement (QI) initiative was to assess whether the implementation of a BV clinical pathway improved management times (epoch 2) compared to data from our previous retrospective analysis (epoch 1). Our secondary objective was to analyze clinical presentation and morbidity/mortality for all cases of BV. Design/Methods This QI study employed a prospective cohort design to evaluate the impact of a new clinical pathway for infants < 3 months presenting with BV. The pathway ‘‘Green code’’ was developed using Plan-Do-Study-Act (PDSA) cycles to identify and address delays in care iteratively. Key interventions included standardized preformatted order set and a clinical practice guideline for BV investigation, expedited imaging protocols on-site, and quicker surgical consultations from arrival. Time intervals were systematically recorded, including: 1. Time to first medical evaluation. 2. Time to radiologic investigations (ultrasound [US], upper gastrointestinal radiography [UGI]). 3. Time to surgical consultation and to surgery for patients diagnosed with MV. Demographic and clinical data were collected for all patients, including signs/symptoms, laboratory studies, and imaging results. Surgical findings were recorded for confirmed MV cases. Comparative analysis of time metrics between the pre-intervention cohort (2015–2022) and post-intervention cohort (2022–2024) was performed using run charts. Results During the period study (09/2022–09/2024), 36 patients were investigated for BV in our institution. The median time to US from arrival was 55 min (17–97) compared to 146 min (63–234) in the pre-QI cohort. Five (9%) patients underwent surgery. The median time to surgery from arrival for the MV group was 103 min (63–138) compared to 297 min (206–368) in the pre-QI cohort. No mortality was recorded in this post-QI cohort. Other timepoints and clinical data were recorded and are currently collected. Conclusion Organizational changes, in the form of a new institutional clinical pathway and guideline created by a multidisciplinary team, proved to be effective tools to reduce investigation time of patients presenting with BV and treatment time of patient with MV. The first line of imaging in the clinical pathway studied is US and should strongly be considered as the primary investigation method for BV.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».