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Joanne N Wood - One of the best experts on this subject based on the ideXlab platform.
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impact of child abuse clinical pathways on Skeletal Survey performance in high risk infants
Academic Pediatrics, 2020Co-Authors: Natalie Stavas, Christine Weirich Paine, Lihai Song, Justine Shults, Joanne N WoodAbstract:Abstract Objective We sought: 1) to examine the association between the presence of a child abuse pathway and the odds of Skeletal Survey performance in infants with injuries associated with high risk of abuse and 2) to determine whether pathway presence decreased disparities in Skeletal Survey performance. Methods In this retrospective study of children Results Among 2085 included cases 55% were male, 69% had public insurance, and 64% were white. Fifty-eight percent presented to a hospital when a pathway was present. Skeletal Surveys were performed in 86% of children between 0 and 5 months and 73% of children 6–11 months. In our regression model, adjusted for covariates (age, race, insurance, injury) the presence of a child abuse pathway in a hospital was associated with greater odds of Skeletal Survey performance (odds ratio [OR], 1.46, 95% confidence interval [CI], 1.02–2.08). Children with public insurance had greater odds of receiving a Skeletal Survey (OR 2.75, 95% CI 2.11–3.52) despite presence of pathway. Conclusions When a child abuse clinical pathway was present, children with injuries associated with a high risk of abuse had a greater odds of receiving a Skeletal Survey. Differences in Skeletal Survey performance exist between infants with public vs. private insurance regardless of a pathway.
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development of guidelines for Skeletal Survey in young children with intracranial hemorrhage
Pediatrics, 2016Co-Authors: Christine Weirich Paine, Russell Localio, Philip V Scribano, Joanne N WoodAbstract:BACKGROUND AND OBJECTIVE: As evidenced by the variation and disparities in evaluation, there is uncertainty in determining which young children with intracranial hemorrhage (ICH) should undergo evaluation with Skeletal Survey (SS) for additional injuries concerning for abuse. We aimed to develop guidelines for performing initial SS in children METHODS: Using the RAND/UCLA Appropriateness Method, a multispecialty panel of 12 experts used the literature and their own clinical expertise to rate the appropriateness of performing SS for 216 scenarios characterizing children RESULTS: Panelists concluded that SS is appropriate for 85% (63), uncertain for 15% (11), and inappropriate for 0% of scenarios. Panelists determined that SS is necessary in all scenarios deemed appropriate. SS was deemed necessary for infants CONCLUSIONS: The resulting clinical guidelines call for near-universal evaluation in children
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development of hospital based guidelines for Skeletal Survey in young children with bruises
Pediatrics, 2015Co-Authors: Joanne N Wood, Oludolapo Fakeye, Chris Feudtner, Valerie Mondestin, Russell Localio, David T RubinAbstract:OBJECTIVE: To develop guidelines for performing an initial Skeletal Survey (SS) for children METHODS: Applying the Rand/UCLA Appropriateness Method, a multispecialty panel of 10 experts relied on evidence from the literature and their own clinical expertise in rating the appropriateness of performing SS for 198 clinical scenarios characterizing children RESULTS: Panelists agreed that SS is “appropriate” for 62% (136/219) of scenarios, and “inappropriate” for children ≥12 months old with nonpatterned bruising on bony prominences. Panelists agreed that SS is “necessary” for 95% (129/136) of the appropriate scenarios. SS was deemed necessary for infants CONCLUSIONS: The appropriateness and necessity of SS in children presenting for care to the hospital setting with bruising, as determined by a diverse panel of experts, depends on age of the child and location of bruising.
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development of guidelines for Skeletal Survey in young children with fractures
Pediatrics, 2014Co-Authors: Joanne N Wood, Oludolapo Fakeye, Chris Feudtner, Valerie Mondestin, Russell Localio, David T RubinAbstract:OBJECTIVE: To develop guidelines for performing initial Skeletal Survey (SS) in children METHODS: Following the Rand/UCLA Method, a multispecialty panel of 13 experts applied evidence from a literature review combined with their own expertise in rating the appropriateness of performing an SS for 525 clinical scenarios involving fractures in children RESULTS: Panelists agreed that SS is “appropriate” for 191 (80%) of 240 scenarios rated and “necessary” for 175 (92%) of the appropriate scenarios. Skeletal Survey is necessary if a fracture is attributed to abuse, domestic violence, or being hit by a toy. With few exceptions, SS is necessary in children without a history of trauma. In children CONCLUSIONS: A multispecialty panel reached agreement on multiple clinical scenarios for which initial SS is indicated in young children with fractures, allowing for synthesis of clinical guidelines with the potential to decrease disparities in care and increase detection of abuse.
Jean E Turnquist - One of the best experts on this subject based on the ideXlab platform.
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Skeletal Survey of cayo santiago rhesus macaques osteoarthritis and articular plate excrescences
Seminars in Arthritis and Rheumatism, 1999Co-Authors: Bruce M Rothschild, Nancy Hong, Jean E TurnquistAbstract:Abstract Objectives: This study was performed to complement studies on spondyloarthropathyin rhesus macaques by quantifying and characterizing another major form of arthritis and contrasting it with osteoarthritis. Methods: Skeletons of 269 macaques of known age and troop affiliation from the free-ranging Cayo Santiago colony (Caribbean Primate Research Center) were macroscopically Surveyed for the presence of articular changes of osteoarthritis, articular plate excrescences, and calcifications that project back over the joint surface in all diarthrodial joints. Statistical tests were used to establish the independence of pathological conditions, age, gender, troop membership, and specific joint involvement. Results: Subchondral articular surface excrescences or calcific plate-like articular surface overgrowth were noted in 17% and osteoarthritis in 18% of Cayo Santiago macaques. Distribution of joint involvement and sex ratio (1:1) of the former condition were independent of either troop membership or the distribution of osteoarthritis. Conclusion: Three major forms of arthritis are common in rhesus macaques:osteoarthritis, spondyloarthropathy, and a category that might be referred to as apical plate excrescences (APE). The latter is very different from spondyloarthropathy, rheumatoid arthritis, osteoarthritis, gout, and infectious arthritis. It is quite similar to what in the past has been referred to as the radiographic form of calcium pyrophosphate deposition disease (CPPD) in humans. A new name has not been offered for the identification/categorization of this phenomenon in dry bone. Its occurrence in rhesus macaques appears to present a natural model for characterization of genetic, immunologic, and environmental aspects of this phenomenon. The acronym APE is offered for consideration in naming this category of arthritis in Skeletal material.
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osteoarthritis of the hand in nonhuman primates a clinical radiographic and Skeletal Survey of cayo santiago rhesus macaques
Journal of Medical Primatology, 1996Co-Authors: Keith Lim, Jean E Turnquist, Matt J Kessler, Kenneth P H Pritzker, Paul DieppeAbstract:: We describe the relative prevalence and pattern of distribution of osteoarthritis (OA) in the hands of elderly (>15 years) rhesus macaques using clinical, radiographic, and Skeletal examinations. In the clinical study the prevalence of nodes was 72% and 16% in the distal inter-phalangeal joints (DIPJ) and proximal inter-phalangeal joints (PIPJ), respectively, 31% of all monkeys had polyarticular nodes. Radiographic OA was present in 55%, 9.1%, and 0% of the DIPJs, PIPJs, and thumb bases, respectively. Skeletal OA as defined by joint surface eburnation for the DIPJ, PIPJ, and thumb base were 16%, 8%, and 2%, respectively. A similar pattern of hand OA with humans is described except for the thumb base OA. This may be due to the relatively rudimentary manipulative role of the macaque thumb. The finding of polyarticular nodal OA raises the possibility of a common pathogenensis for IPJ OA amongst primates.
Jens Hillengass - One of the best experts on this subject based on the ideXlab platform.
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international myeloma working group consensus recommendations on imaging in monoclonal plasma cell disorders
Lancet Oncology, 2019Co-Authors: Jens Hillengass, Saad Z Usmani, Vincent S Rajkumar, Brian G M Durie, Mariavictoria Mateos, Sagar Lonial, Cristina Joao, Kenneth C Anderson, Ramon Garciasanz, Eloisa RivaAbstract:Summary Recent advances in the treatment of multiple myeloma have increased the need for accurate diagnosis of the disease. The detection of bone and bone marrow lesions is crucial in the investigation of multiple myeloma and often dictates the decision to start treatment. Furthermore, detection of minimal residual disease is important for prognosis determination and treatment planning, and it has underscored an unmet need for sensitive imaging methods that accurately assess patient response to multiple myeloma treatment. Low-dose whole-body CT has increased sensitivity compared with conventional Skeletal Survey in the detection of bone disease, which can reveal information leading to changes in therapy and disease management that could prevent or delay the onset of clinically significant morbidity and mortality as a result of Skeletal-related events. Given the multiple options available for the detection of bone and bone marrow lesions, ranging from conventional Skeletal Survey to whole-body CT, PET/CT, and MRI, the International Myeloma Working Group decided to establish guidelines on optimal use of imaging methods at different disease stages. These recommendations on imaging within and outside of clinical trials will help standardise imaging for monoclonal plasma cell disorders worldwide to allow the comparison of results and the unification of treatment approaches for multiple myeloma.
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whole body computed tomography versus conventional Skeletal Survey in patients with multiple myeloma a study of the international myeloma working group
Blood Cancer Journal, 2017Co-Authors: Jens Hillengass, Jennifer Mosebach, Matthew T. Drake, B Oestergaard, Niels Abildgaard, Thomas Hielscher, Stefan Delorme, Lia A Moulopoulos, S V Rajkumar, Maja HingeAbstract:For decades, conventional Skeletal Survey (CSS) has been the standard imaging technique for multiple myeloma (MM). However, recently whole-body computed tomography (WBCT) has been implemented into the diagnostic criteria of MM. This analysis compares sensitivity and prognostic significance of WBCT and CSS in patients with smoldering MM (SMM) and MM. Fifty-four of 212 patients (25.5%) had a negative CSS and a positive WBCT for osteolytic lesions (P<0.0001). Of 66 patients with SMM based on CSS, 12 (22.2%) had osteolytic lesions on WBCT. In comparison, WBCT failed to detect some bone destructions in the appendicular skeleton possibly due to limitations of the field of view. Presence of lytic bone lesions in WBCT was of borderline prognostic significance (P=0.051) for SMM patients, with a median time to progression of 38 versus 82 months for those without bone destructions. In conclusion, WBCT identifies significantly more sites of bone destruction than CSS. More than 20% of patients with SMM according to CSS have in fact active MM detectable with WBCT. On the basis of this and other studies, WBCT (either computed tomography (CT) alone or as part of a positron emission tomography-CT protocol) should be considered the current standard for the detection of osteolytic lesions in MM.
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findings of whole body computed tomography compared to conventional Skeletal Survey in patients with monoclonal plasma cell disorders a study of the international myeloma working group
Blood, 2016Co-Authors: Matthew T. Drake, Thomas Hielscher, Stefan Delorme, Jens Hillengass, Lia A Monopoulos, Vassilis Koutoulidis, Jessica Engelhart, Vincent Rajkumar, Brian OstergaardAbstract:![Graphic][1] Introduction: For decades conventional Skeletal Survey (CSS) has been the standard imaging technique for the detection of bone impairment caused by Multiple Myeloma (MM). The development of cross-sectional imaging techniques like Whole Body Computed Tomography (WBCT) with or without Positron Emission Tomography (PET/PET-CT) and magnetic resonance imaging (MRI) led to the use of these techniques in several centers worldwide and to the implementation of their findings into the revised diagnostic criteria of MM. The aim of the current multicenter study was to compare sensitivity and prognostic significance of WBCT and CSS in patients with monoclonal plasma disorders. Methods: For the current retrospective analysis 308 patients with different stages of monoclonal plasma cell disorders from 8 centers were included. Compact discs with pseudonymized imaging data of WBCT and CSS were sent to the organizing center and uploaded to the picture archiving and communication system. In addition, questionnaires were completed by each center to collect clinical data of the patients. Image analysis was performed in consensus reading by three experienced radiologists (LAM, SD, VK) blinded to the clinical data of the patients. Osteolytic lesions in 19 pre-specified anatomic regions were characterized as "definitely present", "probably present", "probably absent" and "definitely absent". For the analysis only "definitely present" and "probably present" entries were counted as myeloma lesions. To define symptomatic or active versus smoldering myeloma based on the presence of bone lesions, findings of CSS were used to simulate the situation before the introduction of WBCT. For comparison of WBCT and CSS only those anatomic regions having valid measurements from both methods performed within 30 days without treatment in the meantime were considered. WBCT and CSS were tested for differences in detection sensitivity with the exact McNemar test. Results: Of 308 submitted datasets; 160 patients were without prior treatment and 56 of them had smoldering myeloma. Of 160 patients 80 (50%) had no osteolytic lesions on either CSS or WBCT and 33 (20.6%) showed osteolyses on both techniques. In 9 patients (5.6%) osteolyses were found on CSS but not in WBCT while 38 patients (23.8%) were positive on CT alone. Of note is that for some CT-scans, the upper extremities were not evaluable due to positioning during the examination. Odds ratio for osteolyses on WBCT compared to CSS was 4.22 (P < 0.0001). The regions where WBCT was most significantly superior in detecting osteolyses were the iliac bone, thoracic and lumbar spine as well as the ribs. CSS compared to WBCT revealed osteolyses in more patients only in the proximal extremities: for left humerus 10 (6.5%) versus 3 (1.9%), right humerus 12 (7.7%) versus 4 (2.6%), left femur 11 (7.1%) versus 7 (4.5%) and right femur 10 (6.5%) versus 8 (5.2%) respectively. Of 157 evaluable patients 63 (40.1%) showed osteoporosis (defined by radiological criteria) on both techniques while 29 (18.5%) had osteoporosis on WBCT only and 10 (6.4%) on CSS only (OR 2.90, P = 0.003). In the 56 patients with smoldering myeloma, with bone disease being defined according to the findings of CSS 12 (21.4%), were positive for osteolyses on WBCT (P = 0.0005). Conclusion: WBCT shows significantly more sites of bone destruction compared to conventional X-ray imaging particularly in Skeletal regions composed primarily of trabecular bone while CSS shows more osteolyses in the appendicular skeleton - in part due to a limited field of view. More than 20% of patients with smoldering myeloma based on CSS have active disease that needs treatment based on WBCT. Therefore, WBCT is the current standard for the detection of osteolytic lesions in myeloma. The prognostic significance of WBCT and CSS findings for survival and correlation with clinical parameters will be reported at the meeting. Disclosures Hillengass: Celgene: Honoraria; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Honoraria; Novartis: Research Funding; Amgen: Consultancy, Honoraria; Sanofi: Research Funding. Plesner: Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding. Dimopoulos: Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Genesis: Consultancy, Honoraria. Goldschmidt: Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Research Funding; Chugai: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Millennium: Membership on an entity's Board of Directors or advisory committees, Research Funding; Onyx: Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees. Lentzsch: Celgene: Consultancy, Honoraria; BMS: Consultancy. Terpos: Takeda: Consultancy, Honoraria; Bristol-Myers Squibb: Consultancy, Honoraria; Genesis: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding; Novartis: Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Celgene: Honoraria. [1]: /embed/inline-graphic-2.gif
Chris Feudtner - One of the best experts on this subject based on the ideXlab platform.
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development of hospital based guidelines for Skeletal Survey in young children with bruises
Pediatrics, 2015Co-Authors: Joanne N Wood, Oludolapo Fakeye, Chris Feudtner, Valerie Mondestin, Russell Localio, David T RubinAbstract:OBJECTIVE: To develop guidelines for performing an initial Skeletal Survey (SS) for children METHODS: Applying the Rand/UCLA Appropriateness Method, a multispecialty panel of 10 experts relied on evidence from the literature and their own clinical expertise in rating the appropriateness of performing SS for 198 clinical scenarios characterizing children RESULTS: Panelists agreed that SS is “appropriate” for 62% (136/219) of scenarios, and “inappropriate” for children ≥12 months old with nonpatterned bruising on bony prominences. Panelists agreed that SS is “necessary” for 95% (129/136) of the appropriate scenarios. SS was deemed necessary for infants CONCLUSIONS: The appropriateness and necessity of SS in children presenting for care to the hospital setting with bruising, as determined by a diverse panel of experts, depends on age of the child and location of bruising.
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development of guidelines for Skeletal Survey in young children with fractures
Pediatrics, 2014Co-Authors: Joanne N Wood, Oludolapo Fakeye, Chris Feudtner, Valerie Mondestin, Russell Localio, David T RubinAbstract:OBJECTIVE: To develop guidelines for performing initial Skeletal Survey (SS) in children METHODS: Following the Rand/UCLA Method, a multispecialty panel of 13 experts applied evidence from a literature review combined with their own expertise in rating the appropriateness of performing an SS for 525 clinical scenarios involving fractures in children RESULTS: Panelists agreed that SS is “appropriate” for 191 (80%) of 240 scenarios rated and “necessary” for 175 (92%) of the appropriate scenarios. Skeletal Survey is necessary if a fracture is attributed to abuse, domestic violence, or being hit by a toy. With few exceptions, SS is necessary in children without a history of trauma. In children CONCLUSIONS: A multispecialty panel reached agreement on multiple clinical scenarios for which initial SS is indicated in young children with fractures, allowing for synthesis of clinical guidelines with the potential to decrease disparities in care and increase detection of abuse.
Daniel M Lindberg - One of the best experts on this subject based on the ideXlab platform.
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follow up Skeletal Survey use by child abuse pediatricians
Child Abuse & Neglect, 2016Co-Authors: Nancy S Harper, Terri L Lewis, Sonja Eddleman, Daniel M LindbergAbstract:Abstract Skeletal Survey is frequently used to identify occult fractures in young children with concern for physical abuse. Because Skeletal Survey is relatively insensitive for some abusive fractures, a follow-up Skeletal Survey (FUSS) may be undertaken at least 10–14 days after the initial Skeletal Survey to improve sensitivity for healing fractures. This was a prospectively planned secondary analysis of a prospective, observational study of 2,890 children who underwent subspecialty evaluation for suspected child physical abuse at 1 of 19 centers. Our objective was to determine variability between sites in rates of FUSS recommendation, completion and fracture identification among the 2,049 participants who had an initial SS. Among children with an initial Skeletal Survey, the rate of FUSS recommendation for sites ranged from 20% to 97%; the rate of FUSS completion ranged from 10% to 100%. Among sites completing at least 10 FUSS, rates of new fracture identification ranged from 8% to 28%. Among completed FUSS, new fractures were more likely to be identified in younger children, children with higher initial level of concern for abuse, and those with a fracture or cutaneous injury identified in the initial evaluation. The current variability in FUSS utilization is not explained by variability in occult fracture prevalence. Specific guidelines for FUSS utilization are needed.
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yield of Skeletal Survey by age in children referred to abuse specialists
The Journal of Pediatrics, 2014Co-Authors: Rachel P Berger, Daniel M Lindberg, Maegan S Reynolds, Riham M Alwan, Nancy S HarperAbstract:Objective To determine rates of Skeletal Survey completion and injury identification as a function of age among children who underwent subspecialty evaluation for concerns of physical abuse. Study design This was a retrospective secondary analysis of an observational study of 2609 children Results Among 2609 subjects, 2036 (78%) had Skeletal Survey and 458 (18%) had at least one new fracture identified. For all age groups up to 36 months, Skeletal Survey was obtained in >50% of subjects, but rates decreased to less than 35% for subjects >36 months. New fracture identification rates for Skeletal Survey were similar between children 24-36 months of age (10.3%, 95% CI 7.2-14.2) and children 12-24 months of age (12.0%, 95% CI 9.2-15.3) Conclusions Skeletal Surveys identify new fractures in an important fraction of children referred for subspecialty consultation with concerns of physical abuse. These data support guidelines that consider Skeletal Survey mandatory for all such children
