Hunter, Lindsay R.

Objective: The purpose of our study was to compare the clinical utility of administering 2 recommended developmental screening instruments, the Infant Developmental Inventory (IDI) and the Ages and Stages Questionnaire (ASQ), at 9-month well-child visits in paper format. Methods: Outcomes of the 2 screens, including correct completion and interpretation by clinician, time of visit, and screen outcome were compared. Results: Out of 33 children administered the ASQ and with documented scores, 12 (36.4%) did not receive passing scores, while 5 (12.2%) of the 41 children administered the IDI did not receive passing scores ( P = .014). Out of 41 IDI screens, 12 (29.3%) were completed incorrectly, while there were no ASQ screens completed incorrectly ( P < .001) by caregivers. Conclusion: In our pilot study, the ASQ is more often completed correctly by caregivers and identifies more children at risk for delay as compared with the IDI. Additional larger scale studies are needed to evaluate the usefulness of developmental screening tools when used within primary care practice.

Purpose The purposes of this study were to determine the frequency of acute and subacute complications (within 6 months) of arthroscopic knee procedures in patients aged 17 years or younger and to determine associated risk factors. Methods We identified all patients aged 17 years or younger who underwent arthroscopic knee procedures at our institution from 1997 to 2009. Patient demographic and surgical data were collected from the medical and surgical records, with specific focus on intraoperative and postoperative complications. Results During the study period, 1,002 knee arthroscopies were reviewed. The overall complication rate was 14.7%. Major complications occurred in 21 surgeries (2.1%) and included the following: septic arthritis (n = 3, 0.3%), wound complication requiring operative revision (n = 9, 0.9%), arthrofibrosis requiring manipulation (n = 4, 0.4%), other unplanned subsequent surgery (n = 4, 0.4%), and death (n = 1, 0.1%). Surgeries with an anesthesia time of 265 minutes or greater ( P = .026), operative time of 220 minutes or greater ( P = .013), or tourniquet time of 114 minutes or greater ( P < .001) and surgeries with 3 or more Current Procedural Terminology codes ( P = .003) had a statistically significant increase in risk of major complications. The incidence of minor complications was 12.6%, which included persistent effusion/hemarthrosis requiring arthrocentesis (n = 59, 5.9%) and superficial wound infection (n = 18, 1.8%). Conclusions Major complications after knee arthroscopy in children and adolescents are rare, but minor complications are more common. If possible, surgeons should avoid prolonged anesthesia, surgery, and tourniquet times. The pediatric patient's medical and family history should be reviewed to identify important risk factors. Level of Evidence Level IV, therapeutic case series.

Objectives: Arthroscopic knee procedures are commonly performed in pediatric/adolescent patients. Reported complications following these procedures are low, however, no childhood specific data exists. Therefore, the purpose of this study is to determine the acute complications (within 6 months) of arthroscopic knee procedures in patients aged 17 years or less. Methods: This is a retrospective review of patients aged 17 years or less who underwent an arthroscopic knee procedure from 1997 to 2009 at a single institution. Demographic and surgical data was collected, in addition to specific data on intra-operative and post-operative complications. Minor complications included peripheral nerve block failure, regional anesthesia failure requiring conversion to general anesthesia, superficial wound infection/dehiscence, persistent knee effusion requiring aspiration, and sensory nerve dysesthesia. Major complications included death, major medical complication, septic arthritis, wound requiring repeat closure, arthrofibrosis, equipment failure, and revision surgery. Results: 1015 patients (555 males (54.7%), 460 females (45.3%)) with average age 15.3 (range 4-17) years were analyzed. The average operative time was 133.9 minutes (range 14-520). 467 (46%) underwent ACL reconstruction, 465 (45.8%) underwent synovectomy, treatment of an OCD lesion, meniscal treatment, or lateral release, 52 (5%) had a medial patellofemoral ligament reconstruction +/- tibial tubercle transfer, 17 (1.7%) arthroscopic fixation of a tibial eminence fracture, and 14 (1.4%) other ligament reconstruction. There were 147 (14.5%) total complications recorded. Major complications occurred in 21 (1.4%) of patients and minor complications in 126 (12.4%) of patients. Major complications included: intra-articular instrument breakage in 1(0.098%), septic arthritis in 4 patients (0.394%), 9 wounds requiring repeat closure (0.886%), arthrofibrosis in 5 patients (0.492%), unplanned subsequent surgical procedure in 3 patients (0.002%), and death in 1 patient (0.098%). 2 patients were readmitted to the hospital (1 DIC, 1 a-fib and syncope). There were no pulmonary emboli or DVTs, and no vascular injuries. No patients developed CRPS. Minor complications included:5 patients (0.492%) sensory nerve paresthesias, 10 (0.985%) patients with failed regional anesthetic, 16 (1.57%) patients with post-operative pain pump that required early discontinuation, 18(1.77%) patients with superficial wound infection/irritation, 60 (5.91%) patients with persistent effusion/hemarthrosis requiring arthrocentesis, and 17(1.67%) patients had medical problems that required intervention (asthma exacerbation, urinary retention). Conclusion: Major complications following knee arthroscopy in children and adolescents are relatively low 1.4%. Minor complications are more common (12.4%) but did not alter the post-operative course or recovery. DVT, PE, and CRPS did not occur in this patient cohort.

Background: Early recognition and treatment of social and emotional disorders in children is significant for school preparation. These disorders are frequently underdetected without the use of standardized screening instruments. The purpose of our study is to describe the implementation of the Ages and Stages Questionnaire: Social–Emotional (ASQ:SE) in primary care practice by mail when children are 30 months old. Methods: In this 4-month study, parents of all 30-month-old children who receive primary care at our study site were mailed the ASQ:SE. In children who did not pass screening or received a call from a registered nurse for parental concerns documented on the questionnaire, short-term clinical outcomes were obtained from the electronic medical record. During the last month of the study, the demographics variables of race and insurance type were analyzed for an association with questionnaire completion by mail. Results: Of the 870 families mailed 30-month ASQ:SE screens, 507 (58.3%) were returned by mail. Out of the children with returned screens, 38 (7.5%) of parents were contacted for either elevated scores or concerning comments and 6 (1.2%) were referred to Early Intervention. Parents of children with government insurance returned the ASQ:SE questionnaire 34.2% (13/38) of the time compared with 65.5% (76/116) of those with private insurance ( P < .001). Conclusion: Our results indicate that mental health screening can be effectively managed in primary care practice by a registered nurse using a follow-up protocol. Mailing the ASQ:SE is likely not an effective way to comprehensively screen most primary care populations.