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'Seat-Belt Sign' Indicates Hidden Abdominal Injury Risk
BOSTON – Children who present to the emergency department with the classic "seat-belt sign" may have intra-abdominal injuries that warrant further investigation, even when they do not exhibit abdominal pain or tenderness, reported investigators at the annual meeting of the Pediatric Academic Societies.
The seat-belt sign – a continuous area of erythema, ecchymosis, or contusion caused by seat-belt pressure during a vehicle collision or impact – was significantly associated with risk for any intra-abdominal injury, reported Dr. Angela Ellison, an emergency physician at the Children’s Hospital of Philadelphia.
One-third of children with the seat-belt sign did not have abdominal pain or tenderness, yet 10% of those who also had an abdominal CT scan were found to have an intra-abdominal injury.
"Children with seat-belt sign are at high risk of intra-abdominal injury, primarily gastrointestinal injury, and are more likely to undergo acute intervention for intra-abdominal injury," Dr. Ellison said, speaking on behalf of colleagues in the Pediatric Emergency Care Applied Research Network.
The investigators analyzed a subset of patients from a prospective multicenter study of children presenting to 20 emergency departments with blunt torso trauma. They identified 3,740 children younger than 18 years with blunt abdominal trauma from a motor vehicle collision, excluding those with injuries older than 24 hours, those with preexisting neurologic disorders, and those transferred with prior abdominal images.
To scan or not to scan was left to the discretion of the treating physician, and clinical data, including findings of the presence or absence of a seat-belt sign, were collected. Patients were followed with a telephone call at 1 week if they were discharged after treatment or with medical records if they were admitted.
The authors found that 585 children (16%) had the seat-belt sign, and 3,155 (84%) did not. In all, 443 patients with the sign (76%) had an abdominal CT, compared with 1,415 (45%) of those lacking the sign (P less than .001). In total, 50% of the study population had an abdominal CT.
Among the patients who underwent CT, 19% of those with the seat-belt sign had some form of intra-abdominal injury, compared with 11% of those who had CT scans but no seat-belt sign (relative risk [RR], 1.6; 95% confidence interval [CI], 1.3-2.1). Gastrointestinal injuries were the most common, occurring in 10% of the seat-belt sign patients and 1% of those with no sign (RR, 9.8; 95% CI, 5.5-17.4). There were no significant differences between the groups in rates of injury to the spleen, liver, kidney, or pancreas.
In multivariate analysis, they found that factors significantly associated with a risk for any intra-abdominal injury were the seat-belt sign (RR, 1.7; P less than .01), hypotension (RR, 2.6; P less than .01), Glasgow Coma Scale score less than 14 (RR, 2.2; P less than .01), decreased breath sounds (RR, 1.7; P = .03), abdominal tenderness (RR, 1.6; P less than .01), and evidence of thoracic trauma (RR, 1.4; P = .03).
Patients with the seat-belt sign were significantly more likely to undergo any acute intervention for intra-abdominal injury (RR, 4.5; 95% CI, 3.0-6.8), nothing-by-mouth orders and intravenous fluids for more than 2 nights (RR, 14.6; 95% CI, 7.1-29.9), laparotomy (RR, 9.5; 95% CI, 5.6-16.1), or blood transfusion (RR, 2.9; 95% CI, 1.6-5.1).
Of the 196 patients with the seat-belt sign but no abdominal pain or tenderness (34%), 103 had abdominal CT and, of this group, 11 (10.7%) had an intra-abdominal injury diagnosed. Of all 196 patients, 4 (2%) required an acute intervention for their injuries.
"Children with seat-belt sign and no abdominal pain or tenderness have a high risk of acute abdominal injury and a non-negligible risk of undergoing acute interventions for intra-abdominal injury. Therefore, we recommend that clinicians strongly consider additional evaluation in this subpopulation of patients," Dr. Ellison said.
The study was supported by the National Center for Injury Prevention and Control and the Health Resources and Services Administration. Dr. Ellison and coauthors reported having no conflicts of interest.
BOSTON – Children who present to the emergency department with the classic "seat-belt sign" may have intra-abdominal injuries that warrant further investigation, even when they do not exhibit abdominal pain or tenderness, reported investigators at the annual meeting of the Pediatric Academic Societies.
The seat-belt sign – a continuous area of erythema, ecchymosis, or contusion caused by seat-belt pressure during a vehicle collision or impact – was significantly associated with risk for any intra-abdominal injury, reported Dr. Angela Ellison, an emergency physician at the Children’s Hospital of Philadelphia.
One-third of children with the seat-belt sign did not have abdominal pain or tenderness, yet 10% of those who also had an abdominal CT scan were found to have an intra-abdominal injury.
"Children with seat-belt sign are at high risk of intra-abdominal injury, primarily gastrointestinal injury, and are more likely to undergo acute intervention for intra-abdominal injury," Dr. Ellison said, speaking on behalf of colleagues in the Pediatric Emergency Care Applied Research Network.
The investigators analyzed a subset of patients from a prospective multicenter study of children presenting to 20 emergency departments with blunt torso trauma. They identified 3,740 children younger than 18 years with blunt abdominal trauma from a motor vehicle collision, excluding those with injuries older than 24 hours, those with preexisting neurologic disorders, and those transferred with prior abdominal images.
To scan or not to scan was left to the discretion of the treating physician, and clinical data, including findings of the presence or absence of a seat-belt sign, were collected. Patients were followed with a telephone call at 1 week if they were discharged after treatment or with medical records if they were admitted.
The authors found that 585 children (16%) had the seat-belt sign, and 3,155 (84%) did not. In all, 443 patients with the sign (76%) had an abdominal CT, compared with 1,415 (45%) of those lacking the sign (P less than .001). In total, 50% of the study population had an abdominal CT.
Among the patients who underwent CT, 19% of those with the seat-belt sign had some form of intra-abdominal injury, compared with 11% of those who had CT scans but no seat-belt sign (relative risk [RR], 1.6; 95% confidence interval [CI], 1.3-2.1). Gastrointestinal injuries were the most common, occurring in 10% of the seat-belt sign patients and 1% of those with no sign (RR, 9.8; 95% CI, 5.5-17.4). There were no significant differences between the groups in rates of injury to the spleen, liver, kidney, or pancreas.
In multivariate analysis, they found that factors significantly associated with a risk for any intra-abdominal injury were the seat-belt sign (RR, 1.7; P less than .01), hypotension (RR, 2.6; P less than .01), Glasgow Coma Scale score less than 14 (RR, 2.2; P less than .01), decreased breath sounds (RR, 1.7; P = .03), abdominal tenderness (RR, 1.6; P less than .01), and evidence of thoracic trauma (RR, 1.4; P = .03).
Patients with the seat-belt sign were significantly more likely to undergo any acute intervention for intra-abdominal injury (RR, 4.5; 95% CI, 3.0-6.8), nothing-by-mouth orders and intravenous fluids for more than 2 nights (RR, 14.6; 95% CI, 7.1-29.9), laparotomy (RR, 9.5; 95% CI, 5.6-16.1), or blood transfusion (RR, 2.9; 95% CI, 1.6-5.1).
Of the 196 patients with the seat-belt sign but no abdominal pain or tenderness (34%), 103 had abdominal CT and, of this group, 11 (10.7%) had an intra-abdominal injury diagnosed. Of all 196 patients, 4 (2%) required an acute intervention for their injuries.
"Children with seat-belt sign and no abdominal pain or tenderness have a high risk of acute abdominal injury and a non-negligible risk of undergoing acute interventions for intra-abdominal injury. Therefore, we recommend that clinicians strongly consider additional evaluation in this subpopulation of patients," Dr. Ellison said.
The study was supported by the National Center for Injury Prevention and Control and the Health Resources and Services Administration. Dr. Ellison and coauthors reported having no conflicts of interest.
BOSTON – Children who present to the emergency department with the classic "seat-belt sign" may have intra-abdominal injuries that warrant further investigation, even when they do not exhibit abdominal pain or tenderness, reported investigators at the annual meeting of the Pediatric Academic Societies.
The seat-belt sign – a continuous area of erythema, ecchymosis, or contusion caused by seat-belt pressure during a vehicle collision or impact – was significantly associated with risk for any intra-abdominal injury, reported Dr. Angela Ellison, an emergency physician at the Children’s Hospital of Philadelphia.
One-third of children with the seat-belt sign did not have abdominal pain or tenderness, yet 10% of those who also had an abdominal CT scan were found to have an intra-abdominal injury.
"Children with seat-belt sign are at high risk of intra-abdominal injury, primarily gastrointestinal injury, and are more likely to undergo acute intervention for intra-abdominal injury," Dr. Ellison said, speaking on behalf of colleagues in the Pediatric Emergency Care Applied Research Network.
The investigators analyzed a subset of patients from a prospective multicenter study of children presenting to 20 emergency departments with blunt torso trauma. They identified 3,740 children younger than 18 years with blunt abdominal trauma from a motor vehicle collision, excluding those with injuries older than 24 hours, those with preexisting neurologic disorders, and those transferred with prior abdominal images.
To scan or not to scan was left to the discretion of the treating physician, and clinical data, including findings of the presence or absence of a seat-belt sign, were collected. Patients were followed with a telephone call at 1 week if they were discharged after treatment or with medical records if they were admitted.
The authors found that 585 children (16%) had the seat-belt sign, and 3,155 (84%) did not. In all, 443 patients with the sign (76%) had an abdominal CT, compared with 1,415 (45%) of those lacking the sign (P less than .001). In total, 50% of the study population had an abdominal CT.
Among the patients who underwent CT, 19% of those with the seat-belt sign had some form of intra-abdominal injury, compared with 11% of those who had CT scans but no seat-belt sign (relative risk [RR], 1.6; 95% confidence interval [CI], 1.3-2.1). Gastrointestinal injuries were the most common, occurring in 10% of the seat-belt sign patients and 1% of those with no sign (RR, 9.8; 95% CI, 5.5-17.4). There were no significant differences between the groups in rates of injury to the spleen, liver, kidney, or pancreas.
In multivariate analysis, they found that factors significantly associated with a risk for any intra-abdominal injury were the seat-belt sign (RR, 1.7; P less than .01), hypotension (RR, 2.6; P less than .01), Glasgow Coma Scale score less than 14 (RR, 2.2; P less than .01), decreased breath sounds (RR, 1.7; P = .03), abdominal tenderness (RR, 1.6; P less than .01), and evidence of thoracic trauma (RR, 1.4; P = .03).
Patients with the seat-belt sign were significantly more likely to undergo any acute intervention for intra-abdominal injury (RR, 4.5; 95% CI, 3.0-6.8), nothing-by-mouth orders and intravenous fluids for more than 2 nights (RR, 14.6; 95% CI, 7.1-29.9), laparotomy (RR, 9.5; 95% CI, 5.6-16.1), or blood transfusion (RR, 2.9; 95% CI, 1.6-5.1).
Of the 196 patients with the seat-belt sign but no abdominal pain or tenderness (34%), 103 had abdominal CT and, of this group, 11 (10.7%) had an intra-abdominal injury diagnosed. Of all 196 patients, 4 (2%) required an acute intervention for their injuries.
"Children with seat-belt sign and no abdominal pain or tenderness have a high risk of acute abdominal injury and a non-negligible risk of undergoing acute interventions for intra-abdominal injury. Therefore, we recommend that clinicians strongly consider additional evaluation in this subpopulation of patients," Dr. Ellison said.
The study was supported by the National Center for Injury Prevention and Control and the Health Resources and Services Administration. Dr. Ellison and coauthors reported having no conflicts of interest.
FROM THE ANNUAL MEETING OF THE PEDIATRIC ACADEMIC SOCIETIES
Major Finding: In all, 10% of children with the seat-belt sign but no abdominal pain or tenderness were found on CT scan to have an intra-abdominal injury.
Data Source: The findings are from a review of data from a prospective observational study.
Disclosures: The study was supported by the National Center for Injury Prevention and Control and the Health Resources and Services Administration. Dr. Ellison and coauthors reported having no conflicts of interest.
Metformin Monotherapy Fails 50% of Children With Type 2 Diabetes
BOSTON – For about half of children with type 2 diabetes, metformin alone is not enough to produce durable glycemic control, a study has shown.
The TODAY trial found that 52% of children failed monotherapy – many by 11 months, Dr. Phil Zeitler said at the annual meeting of the Pediatric Academic Societies.
And although the addition of rosiglitazone to metformin did improve results, the take-home message about monotherapy is clear, he said: Many young people with type 2 diabetes are going to need multiple medications, or insulin, within a few years of diagnosis.
"Metformin is not as good a medicine as we all thought it was. This is a much more rapid loss of control than we see in adults, in which metformin failure is about 6%-10% per year. And while the addition of rosiglitazone reduced the loss of glycemic control by 23%, the time to failure was unchanged," said Dr. Zeitler, a lead investigator in the Treatment Options for Type 2 Diabetes in Adolescents and Youth trial.
The study’s third arm – a combination of metformin and lifestyle modification – was not significantly different than either monotherapy or dual therapy. Patients using the combination of nutritional and activity counseling plus medication did lose significantly more weight than did those in the medication-only arms, but that did not translate into a longer period of glycemic control.
The study was simultaneously publishedin the online edition of the New England Journal of Medicine (2012 April 29 [doi:10.1056/NEJMoa1109333]).
The 60-month trial started 699 patients aged 10-17 years on 2,000 mg/day metformin; this treatment was continued until hemoglobin A1c stabilized at 8%. The group was then randomized to one of the three treatment arms. The primary end point was time to the failure of glycemic control, defined as an HbA1c level of at least 8% for 6 months, or sustained metabolic decompensation that required insulin treatment.
Overall, nearly half of the cohort (46%) failed to maintain glycemic control; the median time to failure was 11 months. However, compared with the combination therapy group, significantly more of those taking metformin alone failed glycemic control (52% vs. 39%). The failure rate in the lifestyle intervention group was 47% – not significantly different from that for metformin monotherapy or combination therapy.
Physiology rather than compliance probably drove the differences, said Dr. Zeitler, head of pediatric endocrinology at the Children’s Hospital Colorado, Aurora.
"There was no reason to suspect that differences [in any of the results] were due to lack of adherence," he said. "In fact, if we look at a comparison of those who failed compared to those who did not, adherence was generally better in those who failed, which might have reflected the efforts of the sites to enforce adherence as the HbA1C levels began to rise."
However, Dr. Zeitler said, the results differed significantly between sexes and racial/ethnic groups. For girls, metformin plus rosiglitazone was significantly better than monotherapy or the combination of metformin and lifestyle modification. For boys, the combination of metformin and lifestyle changes was significantly better than for the other groups.
"Metformin is not as good a medicine as we all thought it was."
"While we saw distinct gender differences in the response, we can only speculate about the reasons behind that," Dr. Zeitler said.
Blacks responded especially poorly to metformin alone, he said, "such that by 12 months, almost 50% had failed treatment. We saw increased [statistically significant] efficacy with the addition of either rosiglitazone or lifestyle changes."
Among Hispanics, there were no statistically significant differences between any of the treatment arms, although Dr. Zeitler said that lifestyle intervention tended to be less effective than drug therapy.
Among whites, there was no difference between metformin and metformin with lifestyle changes. These patients had a better response with the addition of rosiglitazone, but it was not statistically significant, he said.
"These very distinct differences in gender and ethnicity suggest that there is something biologic going on here. But we need to analyze a variety of things that could also be factors, including adherence, socioeconomic status, site location, depression, and other things. We do have those data, and those analyses will be forthcoming," Dr. Zeitler said.
Despite the benefit rosiglitazone conferred to some patients, it can’t be recommended as an add-on therapy for young people with type 2 diabetes, he said in an interview. "It’s been shown to increase cardiovascular events in adults, although we don’t know how it would affect young people who are typically more cardiovascularly healthy."
TODAY made it clear that metformin alone isn’t enough for about half of these young patients. However, Dr. Zeitler said, this glass is not just half-empty.
"Half of the youngsters do seem to maintain long-term control irrespective of treatment, and this is something we don’t want to lose sight of," he said. "This suggests there are two cohorts of patients: One that will continue to do well on monotherapy, and one that will fail very rapidly. If we could predict who those children will be at the time of diagnosis, that could have a substantial effect on our choice of treatment."
The study was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Zeitler said he had no relevant financial disclosures. However, several of the coauthors did note financial relationships with various pharmaceutical companies, including Daiichi-Sankyo, Merck, Bristol-Meyers-Squibb, Jenny Craig/Nestle, and Medtronic.
BOSTON – For about half of children with type 2 diabetes, metformin alone is not enough to produce durable glycemic control, a study has shown.
The TODAY trial found that 52% of children failed monotherapy – many by 11 months, Dr. Phil Zeitler said at the annual meeting of the Pediatric Academic Societies.
And although the addition of rosiglitazone to metformin did improve results, the take-home message about monotherapy is clear, he said: Many young people with type 2 diabetes are going to need multiple medications, or insulin, within a few years of diagnosis.
"Metformin is not as good a medicine as we all thought it was. This is a much more rapid loss of control than we see in adults, in which metformin failure is about 6%-10% per year. And while the addition of rosiglitazone reduced the loss of glycemic control by 23%, the time to failure was unchanged," said Dr. Zeitler, a lead investigator in the Treatment Options for Type 2 Diabetes in Adolescents and Youth trial.
The study’s third arm – a combination of metformin and lifestyle modification – was not significantly different than either monotherapy or dual therapy. Patients using the combination of nutritional and activity counseling plus medication did lose significantly more weight than did those in the medication-only arms, but that did not translate into a longer period of glycemic control.
The study was simultaneously publishedin the online edition of the New England Journal of Medicine (2012 April 29 [doi:10.1056/NEJMoa1109333]).
The 60-month trial started 699 patients aged 10-17 years on 2,000 mg/day metformin; this treatment was continued until hemoglobin A1c stabilized at 8%. The group was then randomized to one of the three treatment arms. The primary end point was time to the failure of glycemic control, defined as an HbA1c level of at least 8% for 6 months, or sustained metabolic decompensation that required insulin treatment.
Overall, nearly half of the cohort (46%) failed to maintain glycemic control; the median time to failure was 11 months. However, compared with the combination therapy group, significantly more of those taking metformin alone failed glycemic control (52% vs. 39%). The failure rate in the lifestyle intervention group was 47% – not significantly different from that for metformin monotherapy or combination therapy.
Physiology rather than compliance probably drove the differences, said Dr. Zeitler, head of pediatric endocrinology at the Children’s Hospital Colorado, Aurora.
"There was no reason to suspect that differences [in any of the results] were due to lack of adherence," he said. "In fact, if we look at a comparison of those who failed compared to those who did not, adherence was generally better in those who failed, which might have reflected the efforts of the sites to enforce adherence as the HbA1C levels began to rise."
However, Dr. Zeitler said, the results differed significantly between sexes and racial/ethnic groups. For girls, metformin plus rosiglitazone was significantly better than monotherapy or the combination of metformin and lifestyle modification. For boys, the combination of metformin and lifestyle changes was significantly better than for the other groups.
"Metformin is not as good a medicine as we all thought it was."
"While we saw distinct gender differences in the response, we can only speculate about the reasons behind that," Dr. Zeitler said.
Blacks responded especially poorly to metformin alone, he said, "such that by 12 months, almost 50% had failed treatment. We saw increased [statistically significant] efficacy with the addition of either rosiglitazone or lifestyle changes."
Among Hispanics, there were no statistically significant differences between any of the treatment arms, although Dr. Zeitler said that lifestyle intervention tended to be less effective than drug therapy.
Among whites, there was no difference between metformin and metformin with lifestyle changes. These patients had a better response with the addition of rosiglitazone, but it was not statistically significant, he said.
"These very distinct differences in gender and ethnicity suggest that there is something biologic going on here. But we need to analyze a variety of things that could also be factors, including adherence, socioeconomic status, site location, depression, and other things. We do have those data, and those analyses will be forthcoming," Dr. Zeitler said.
Despite the benefit rosiglitazone conferred to some patients, it can’t be recommended as an add-on therapy for young people with type 2 diabetes, he said in an interview. "It’s been shown to increase cardiovascular events in adults, although we don’t know how it would affect young people who are typically more cardiovascularly healthy."
TODAY made it clear that metformin alone isn’t enough for about half of these young patients. However, Dr. Zeitler said, this glass is not just half-empty.
"Half of the youngsters do seem to maintain long-term control irrespective of treatment, and this is something we don’t want to lose sight of," he said. "This suggests there are two cohorts of patients: One that will continue to do well on monotherapy, and one that will fail very rapidly. If we could predict who those children will be at the time of diagnosis, that could have a substantial effect on our choice of treatment."
The study was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Zeitler said he had no relevant financial disclosures. However, several of the coauthors did note financial relationships with various pharmaceutical companies, including Daiichi-Sankyo, Merck, Bristol-Meyers-Squibb, Jenny Craig/Nestle, and Medtronic.
BOSTON – For about half of children with type 2 diabetes, metformin alone is not enough to produce durable glycemic control, a study has shown.
The TODAY trial found that 52% of children failed monotherapy – many by 11 months, Dr. Phil Zeitler said at the annual meeting of the Pediatric Academic Societies.
And although the addition of rosiglitazone to metformin did improve results, the take-home message about monotherapy is clear, he said: Many young people with type 2 diabetes are going to need multiple medications, or insulin, within a few years of diagnosis.
"Metformin is not as good a medicine as we all thought it was. This is a much more rapid loss of control than we see in adults, in which metformin failure is about 6%-10% per year. And while the addition of rosiglitazone reduced the loss of glycemic control by 23%, the time to failure was unchanged," said Dr. Zeitler, a lead investigator in the Treatment Options for Type 2 Diabetes in Adolescents and Youth trial.
The study’s third arm – a combination of metformin and lifestyle modification – was not significantly different than either monotherapy or dual therapy. Patients using the combination of nutritional and activity counseling plus medication did lose significantly more weight than did those in the medication-only arms, but that did not translate into a longer period of glycemic control.
The study was simultaneously publishedin the online edition of the New England Journal of Medicine (2012 April 29 [doi:10.1056/NEJMoa1109333]).
The 60-month trial started 699 patients aged 10-17 years on 2,000 mg/day metformin; this treatment was continued until hemoglobin A1c stabilized at 8%. The group was then randomized to one of the three treatment arms. The primary end point was time to the failure of glycemic control, defined as an HbA1c level of at least 8% for 6 months, or sustained metabolic decompensation that required insulin treatment.
Overall, nearly half of the cohort (46%) failed to maintain glycemic control; the median time to failure was 11 months. However, compared with the combination therapy group, significantly more of those taking metformin alone failed glycemic control (52% vs. 39%). The failure rate in the lifestyle intervention group was 47% – not significantly different from that for metformin monotherapy or combination therapy.
Physiology rather than compliance probably drove the differences, said Dr. Zeitler, head of pediatric endocrinology at the Children’s Hospital Colorado, Aurora.
"There was no reason to suspect that differences [in any of the results] were due to lack of adherence," he said. "In fact, if we look at a comparison of those who failed compared to those who did not, adherence was generally better in those who failed, which might have reflected the efforts of the sites to enforce adherence as the HbA1C levels began to rise."
However, Dr. Zeitler said, the results differed significantly between sexes and racial/ethnic groups. For girls, metformin plus rosiglitazone was significantly better than monotherapy or the combination of metformin and lifestyle modification. For boys, the combination of metformin and lifestyle changes was significantly better than for the other groups.
"Metformin is not as good a medicine as we all thought it was."
"While we saw distinct gender differences in the response, we can only speculate about the reasons behind that," Dr. Zeitler said.
Blacks responded especially poorly to metformin alone, he said, "such that by 12 months, almost 50% had failed treatment. We saw increased [statistically significant] efficacy with the addition of either rosiglitazone or lifestyle changes."
Among Hispanics, there were no statistically significant differences between any of the treatment arms, although Dr. Zeitler said that lifestyle intervention tended to be less effective than drug therapy.
Among whites, there was no difference between metformin and metformin with lifestyle changes. These patients had a better response with the addition of rosiglitazone, but it was not statistically significant, he said.
"These very distinct differences in gender and ethnicity suggest that there is something biologic going on here. But we need to analyze a variety of things that could also be factors, including adherence, socioeconomic status, site location, depression, and other things. We do have those data, and those analyses will be forthcoming," Dr. Zeitler said.
Despite the benefit rosiglitazone conferred to some patients, it can’t be recommended as an add-on therapy for young people with type 2 diabetes, he said in an interview. "It’s been shown to increase cardiovascular events in adults, although we don’t know how it would affect young people who are typically more cardiovascularly healthy."
TODAY made it clear that metformin alone isn’t enough for about half of these young patients. However, Dr. Zeitler said, this glass is not just half-empty.
"Half of the youngsters do seem to maintain long-term control irrespective of treatment, and this is something we don’t want to lose sight of," he said. "This suggests there are two cohorts of patients: One that will continue to do well on monotherapy, and one that will fail very rapidly. If we could predict who those children will be at the time of diagnosis, that could have a substantial effect on our choice of treatment."
The study was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Zeitler said he had no relevant financial disclosures. However, several of the coauthors did note financial relationships with various pharmaceutical companies, including Daiichi-Sankyo, Merck, Bristol-Meyers-Squibb, Jenny Craig/Nestle, and Medtronic.
FROM THE ANNUAL MEETING OF THE PEDIATRIC ACADEMIC SOCIETIES
Major Finding: Metformin alone did not provide long-lasting glycemic control for 52% of children, metformin plus rosiglitazone decreased glycemic failure by 23%, and metformin plus lifestyle modification was not significantly different from either of the drug-only regimens.
Data Source: TODAY was a three-armed, randomized controlled trial of 699 young people with type 2 diabetes.
Disclosures: The study was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Zeitler said he had no relevant financial disclosures. However, several of the coauthors did note financial relationships with various pharmaceutical companies, including Daiichi-Sankyo, Merck, Bristol-Meyers-Squibb, Jenny Craig/Nestle, and Medtronic.
Pediatric Asthma Admissions Varied Greatly By Neighborhood
BOSTON – Asthma admissions, like politics, are local.
So suggests the wide variability within a single Ohio county in hospitalization rates for children with acute asthma, Dr. Andrew F. Beck, a fellow in general and community pediatrics at Cincinnati Children’s Hospital Medical Center, said at the annual meeting of the Pediatric Academic Societies.
A neighborhood-by-neighborhood analysis of pediatric asthma admissions in Hamilton County (Cincinnati and environs), showed that some neighborhoods had admission rates as high as 27 per 1,000 children aged 1-16 years while others recorded no pediatric asthma hospitalizations at all, Dr. Beck reported.
"Hamilton County had an admission rate double the national average, with profound in-county variation in admission distribution," he noted. "Given this variation, we expect that neighborhood would be a powerful unit of measure that would be easily translatable to members of the community."
Armed with highly localized data, public health authorities could develop more effective interventions targeted at reducing disparities in asthma care, theoretically reducing admissions and saving millions of health care dollars, he explained.
To characterize variations in asthma admission rates among Hamilton County neighborhoods and assess differences in patient- and neighborhood-level characteristics, the investigators drew data from the population-based, prospective, observational Greater Cincinnati Asthma Risks Study.
They looked at 862 sequential admissions of 757 patients for asthma or wheezing from September 2010 through August 2011 of all children aged 1-16 years with addresses within the county.
All of the admissions were at Cincinnati Children’s Hospital Medical Center, which accounts for about 95% of all county admissions, according to Ohio public health data. To reduce the likelihood of confounding variables, the researchers excluded children with respiratory or cardiovascular comorbidities.
The mean overall admission rate for the county was 5.1 per 1,000 children; that compares with a national average of about 2.5 per 1,000, Dr. Beck noted. Neighborhoods whose residents had the highest third of admission rates averaged 17.0 per 1,000, compared with 7.5 per 1,000 for the middle third and 2.6 per 1,000 for the bottom third.
"If the county rate were reduced to that of the lowest tertile, annual admissions would decrease by more than 50% and $2.1 million could be saved," Dr. Beck said.
The researchers used factors chosen from U.S. Census data to determine differences among the three admission-rate groups. They found that lower household incomes, lower levels of education, greater population density, and lower percentage of home ownership within neighborhoods were all significantly predictive of higher asthma admission rates (P less than .0001 for all factors).
The authors also looked at available survey data for 447 patients, grouped into tertiles with respect to patient factors that are known to affect asthma morbidity. Factors significantly associated with a greater chance of admission included patient-reported "difficulty making ends meet," lack of transportation, cockroach infestation, depressive symptoms, and running out of medications (P less than .01 for all comparisons).
The investigators plan to create multilevel models for assessing the degree to which specific factors may affect asthma morbidity, and they hope to better delineate "geographic hot spots" of potentially modifiable risks, Dr. Beck said.
The study was supported by a National Institutes of Health grant and a National Research Service Award grant. The investigators reported having no relevant financial disclosures.
BOSTON – Asthma admissions, like politics, are local.
So suggests the wide variability within a single Ohio county in hospitalization rates for children with acute asthma, Dr. Andrew F. Beck, a fellow in general and community pediatrics at Cincinnati Children’s Hospital Medical Center, said at the annual meeting of the Pediatric Academic Societies.
A neighborhood-by-neighborhood analysis of pediatric asthma admissions in Hamilton County (Cincinnati and environs), showed that some neighborhoods had admission rates as high as 27 per 1,000 children aged 1-16 years while others recorded no pediatric asthma hospitalizations at all, Dr. Beck reported.
"Hamilton County had an admission rate double the national average, with profound in-county variation in admission distribution," he noted. "Given this variation, we expect that neighborhood would be a powerful unit of measure that would be easily translatable to members of the community."
Armed with highly localized data, public health authorities could develop more effective interventions targeted at reducing disparities in asthma care, theoretically reducing admissions and saving millions of health care dollars, he explained.
To characterize variations in asthma admission rates among Hamilton County neighborhoods and assess differences in patient- and neighborhood-level characteristics, the investigators drew data from the population-based, prospective, observational Greater Cincinnati Asthma Risks Study.
They looked at 862 sequential admissions of 757 patients for asthma or wheezing from September 2010 through August 2011 of all children aged 1-16 years with addresses within the county.
All of the admissions were at Cincinnati Children’s Hospital Medical Center, which accounts for about 95% of all county admissions, according to Ohio public health data. To reduce the likelihood of confounding variables, the researchers excluded children with respiratory or cardiovascular comorbidities.
The mean overall admission rate for the county was 5.1 per 1,000 children; that compares with a national average of about 2.5 per 1,000, Dr. Beck noted. Neighborhoods whose residents had the highest third of admission rates averaged 17.0 per 1,000, compared with 7.5 per 1,000 for the middle third and 2.6 per 1,000 for the bottom third.
"If the county rate were reduced to that of the lowest tertile, annual admissions would decrease by more than 50% and $2.1 million could be saved," Dr. Beck said.
The researchers used factors chosen from U.S. Census data to determine differences among the three admission-rate groups. They found that lower household incomes, lower levels of education, greater population density, and lower percentage of home ownership within neighborhoods were all significantly predictive of higher asthma admission rates (P less than .0001 for all factors).
The authors also looked at available survey data for 447 patients, grouped into tertiles with respect to patient factors that are known to affect asthma morbidity. Factors significantly associated with a greater chance of admission included patient-reported "difficulty making ends meet," lack of transportation, cockroach infestation, depressive symptoms, and running out of medications (P less than .01 for all comparisons).
The investigators plan to create multilevel models for assessing the degree to which specific factors may affect asthma morbidity, and they hope to better delineate "geographic hot spots" of potentially modifiable risks, Dr. Beck said.
The study was supported by a National Institutes of Health grant and a National Research Service Award grant. The investigators reported having no relevant financial disclosures.
BOSTON – Asthma admissions, like politics, are local.
So suggests the wide variability within a single Ohio county in hospitalization rates for children with acute asthma, Dr. Andrew F. Beck, a fellow in general and community pediatrics at Cincinnati Children’s Hospital Medical Center, said at the annual meeting of the Pediatric Academic Societies.
A neighborhood-by-neighborhood analysis of pediatric asthma admissions in Hamilton County (Cincinnati and environs), showed that some neighborhoods had admission rates as high as 27 per 1,000 children aged 1-16 years while others recorded no pediatric asthma hospitalizations at all, Dr. Beck reported.
"Hamilton County had an admission rate double the national average, with profound in-county variation in admission distribution," he noted. "Given this variation, we expect that neighborhood would be a powerful unit of measure that would be easily translatable to members of the community."
Armed with highly localized data, public health authorities could develop more effective interventions targeted at reducing disparities in asthma care, theoretically reducing admissions and saving millions of health care dollars, he explained.
To characterize variations in asthma admission rates among Hamilton County neighborhoods and assess differences in patient- and neighborhood-level characteristics, the investigators drew data from the population-based, prospective, observational Greater Cincinnati Asthma Risks Study.
They looked at 862 sequential admissions of 757 patients for asthma or wheezing from September 2010 through August 2011 of all children aged 1-16 years with addresses within the county.
All of the admissions were at Cincinnati Children’s Hospital Medical Center, which accounts for about 95% of all county admissions, according to Ohio public health data. To reduce the likelihood of confounding variables, the researchers excluded children with respiratory or cardiovascular comorbidities.
The mean overall admission rate for the county was 5.1 per 1,000 children; that compares with a national average of about 2.5 per 1,000, Dr. Beck noted. Neighborhoods whose residents had the highest third of admission rates averaged 17.0 per 1,000, compared with 7.5 per 1,000 for the middle third and 2.6 per 1,000 for the bottom third.
"If the county rate were reduced to that of the lowest tertile, annual admissions would decrease by more than 50% and $2.1 million could be saved," Dr. Beck said.
The researchers used factors chosen from U.S. Census data to determine differences among the three admission-rate groups. They found that lower household incomes, lower levels of education, greater population density, and lower percentage of home ownership within neighborhoods were all significantly predictive of higher asthma admission rates (P less than .0001 for all factors).
The authors also looked at available survey data for 447 patients, grouped into tertiles with respect to patient factors that are known to affect asthma morbidity. Factors significantly associated with a greater chance of admission included patient-reported "difficulty making ends meet," lack of transportation, cockroach infestation, depressive symptoms, and running out of medications (P less than .01 for all comparisons).
The investigators plan to create multilevel models for assessing the degree to which specific factors may affect asthma morbidity, and they hope to better delineate "geographic hot spots" of potentially modifiable risks, Dr. Beck said.
The study was supported by a National Institutes of Health grant and a National Research Service Award grant. The investigators reported having no relevant financial disclosures.
FROM THE ANNUAL MEETING OF THE PEDIATRIC ACADEMIC SOCIETIES
Major Finding: In one Ohio county, asthma admission rates by neighborhood ranged from 2.6 per 1,000 to 17 per 1,000 children over 1 year. The U.S. average is about 2.5 per 1,000.
Data Source: In a prospective, observational study, data on 862 sequential admissions of 757 patients were reviewed.
Disclosures: The study was supported by a National Institutes of Health grant and a National Research Service Award grant. The investigators reported having no relevant financial disclosures.