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Diagnostic value of CT scans in pediatric patients with acute non-traumatic altered mental status: a systematic review and meta-analysis.
No full textBACKGROUND: Computed tomography (CT) scans are widely used for evaluating children with acute atraumatic altered mental status (AMS) despite concerns about radiation exposure and limited diagnostic yield. This study aims to assess the efficacy of CT scans in this population and provide evidence-based recommendations.
METHODS: A systematic review was conducted according to PRISMA guidelines. Comprehensive searches were performed in PubMed, Embase, Cochrane Library, Scopus, and Web of Science for studies involving pediatric patients with acute atraumatic AMS undergoing head CT scans. Two independent reviewers conducted the literature search, extracted data, and assessed study quality.
RESULTS: From 4,739 identified studies, 13 met the inclusion criteria. The overall positive diagnostic yield of head CT scans was 35.9% (95% CI: 6.1%-65.7%). Subgroup analyses revealed that the diagnostic yield varied by clinical setting, age group, and presenting symptoms.
CONCLUSION: Head CT scans are frequently performed in pediatric patients with AMS, but their diagnostic usefulness is limited. Evidence-based guidelines and risk stratification methods are necessary to improve imaging utilization and minimize radiation exposure risks. What is Known • Computed tomography (CT) scans are commonly used to evaluate pediatric patients with acute atraumatic altered mental status (AMS). • There are concerns about radiation exposure from CT scans, especially in children due to their increased sensitivity and longer life expectancy. • Previous studies suggest a low diagnostic yield of CT scans in certain pediatric conditions, indicating potential overuse. What is New • This systematic review and meta-analysis specifically assess the diagnostic value of CT scans in pediatric patients with acute atraumatic AMS. • Findings reveal a relatively low positive diagnostic yield, indicating that CT scans may be overutilized in this population. • Subgroup analyses highlight variability in outcomes based on clinical setting, patient age, and presenting symptoms. • The study underscores the need for evidence-based guidelines and risk stratification tools to optimize imaging decisions and reduce unnecessary radiation exposure in children
A Retrospective Analysis Exploring the Impact of Psychiatric Comorbidities on the Time to Initiate HIV Treatment
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Synchronous Primary Malignancy Adenocarcinoma of Colon and Goblet Cell Adenocarcinoma of Appendix: A Case Report
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Enflonsia (clesrovimab-cfor): A New Era in RSV Protection for Infants
Get PDFRespiratory Syncytial Virus (RSV) is a leading cause of serious lung infections in infants and young children, especially during the winter months. For decades, preventative options were limited, costly, or only available to babies at high-risk. The FDA approved Enflonsia (clesrovimab-cfor) in June 2025, given as a single injection to protect infants thorough their first RSV season. Since it is designed for broader infant use and can be distributed through programs such as Vaccines for Children, Enflonsia may help close long-standing gaps in RSV prevention
Reduction of Overall Antibiotic Utilization Rate in a Level IV Neonatal Intensive Care Unit.
No full textOBJECTIVE: Antibiotics are the most frequently prescribed pharmacologic agents in the neonatal intensive care unit (NICU). Antibiotic treatment for suspected or culture-negative sepsis surpasses that for culture-proven infection. Therefore, we sought to reduce our overall antibiotic utilization rate (AUR), defined by total antibiotic days per 1000 patient days (DOT/1000-PD), by 20% within a 4-year period (by December 2023).
METHODS: A multidisciplinary team was convened to develop an antibiotic stewardship quality improvement initiative in our 39-bed level IV NICU. Consensus guidelines for antibiotic duration for common indications were developed. Interventions included educational sessions, antibiotic stop dates, and antibiotic necessity documentation in the electronic health record to standardize provider justification for antibiotic prescription and duration.
RESULTS: A total of 552 infants were included in the analysis, 137 in the baseline and 415 in the postintervention period. Overall AUR decreased by 50% from 278 to 140 DOT/1000-PDs. AUR related to culture-negative sepsis diagnoses decreased by 64% from 22 to 8 DOT/1000-PDs. The percent of antibiotic therapy reinitiation within 2 weeks remained unchanged.
CONCLUSION: Implementation of NICU antibiotic consensus guidelines supported by evidence-based education on culture-negative sepsis diagnosis can effectively reduce antibiotic use in a safe manner, despite a heterogenous, high acuity, level IV NICU population. Multidisciplinary team support and standardization of antibiotic justification in the electronic health record can be coupled to reinforce compliance with established guidelines to promote long-lasting antibiotic reduction
