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Predictive risk score of respiratory complications in children with mediastinal tumors: A case-control study
Mamoru Honda1, Arakawa Yuki1, Hosokawa Takahiro2
1Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan.
Insights
A new risk score combining clinical symptoms and CT findings can predict respiratory complications in children with mediastinal tumors. This tool aids in early identification and management of at-risk pediatric patients.
Area of Science:
- Pediatric Oncology
- Thoracic Surgery
- Respiratory Medicine
Background:
- Mediastinal tumors are rare in children and adolescents.
- Respiratory complications pose a significant risk during diagnosis and treatment.
- Effective risk stratification is crucial for managing these patients.
Purpose of the Study:
- To identify risk factors for respiratory complications in pediatric patients with mediastinal tumors.
- To develop a predictive algorithm for respiratory complications.
- To establish a clinical management strategy for these patients.
Main Methods:
- Retrospective collection of clinical data from 57 pediatric patients with mediastinal tumors (1999-2019).
- Analysis of clinical symptoms, chest CT findings, and respiratory complications.
- Development of a risk score combining clinical and radiological parameters.
Main Results:
- 12% of patients experienced respiratory complications.
- Clinical symptoms (cough, dyspnea, hypoxia, orthopnea) and CT findings (%TCA reduction, carina compression) were significant predictors.
- A risk score (≥7) demonstrated high predictive accuracy (sensitivity 100%, specificity 97.7%) for complications.
Conclusions:
- A risk score integrating clinical and radiological data is a valuable tool for predicting respiratory complications.
- This predictive model can aid in timely intervention and improved outcomes for children with mediastinal tumors.
Background:
The aim of this study was to examine risk factors of respiratory complications at the diagnosis and establish an algorithm of clinical management in children and adolescents with mediastinal tumors.
Methods:
We retrospectively collected clinical information of all children and adolescents who presented with mediastinal tumors at Saitama Children's Medical Center from 1999 to 2019, including age, sex, pathological diagnosis, eight major clinical symptoms (cough, dyspnea, hypoxia, orthopnea, chest pain, wheeze, superior vena cava syndrome, and stridor), chest computed tomography (CT) findings (tumor location, mediastinal mass ratio, pleural fluid, pericardial effusion, and compression of trachea and bronchi), types of diagnostic procedure and anesthesia, respiratory complications (severe hypoxia, difficult ventilation, respiratory failure, and cardiopulmonary arrest), and clinical outcome. Subsequently, we calculated the risk score for predicting respiratory complications by combining clinical and radiological findings.
Results:
Of the 57 patients, 7 (12%) developed respiratory complications. Cough, dyspnea, hypoxia, and orthopnea were significantly more common in patients with complications (p = 0.02, p = 0.02, p < 0.01, p = 0.03, respectively). The reduction of percentage of tracheal cross-sectional area (%TCA) and compression of the carina in chest CT were also significantly more common in patients with complications (p < 0.01 and <0.01, respectively). We calculated the risk score of respiratory complications by combining cough, wheeze, stridor, orthopnea, dyspnea, hypoxia, %TCA < 0.5, and compression of the carina. A risk score ≥ 7 showed high predictive accuracy for complications (sensitivity: 100%, specificity: 97.7%, positive likelihood ratio: 43.0).
Conclusion:
The risk score combining clinical symptoms with radiological findings is a promising predictive tool for respiratory complications in children with mediastinal tumors.
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