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Article ; Online: Recovery of Vocal Cord Motion Among Pediatric Patients.

Prestwood, Courtney Ann / Brown, Ashley F / Johnson, Romaine F

The Annals of otology, rhinology, and laryngology

2021 Volume 131, Issue 6, Page(s) 587–594

Abstract: Objectives: Patients with vocal cord paralysis can experience feeding, respiratory, and vocal problems leading to disability and decreased quality of life. Current evidence suggests waiting a period of 12 months for spontaneous recovery before permanent ...

Abstract	Objectives: Patients with vocal cord paralysis can experience feeding, respiratory, and vocal problems leading to disability and decreased quality of life. Current evidence suggests waiting a period of 12 months for spontaneous recovery before permanent interventions. This study aims to determine the time to recover spontaneously and vocal cord movement in a pediatric population and create a model for evidence-based patient counseling. Study design: Retrospective longitudinal cohort study. Methods: The report is a single institution longitudinal study on vocal cord paralysis recovery. Patients were categorized based on spontaneous recovery with vocal cord movement or no recovery. Recovery rates were determined using the Kaplan-Meier method. Results: Of 158 cases of vocal cord paralysis over a 4-year period, 36 had spontaneous recovery with symptom improvement and motion return. The average recovery was 8.8 months for those who recovered, and 78% recovered within 9 months. Two groups emerged from the data: an early recovery group with spontaneous recovery before 12 months and a late recovery group after 12 months. Children with dysphonia and paralysis due to cardiac surgery were less likely to recover, and children with aspiration were more likely to recover. Children with gastrointestinal comorbidities were less likely to recover; however, those who did recover were more likely to have recovered after 12 months. Based on our model, there is about a 3% chance of recovery between 9 and 12 months. Conclusions: Patients should be counseled about earlier interventions. Waiting the conventional 12 months for only a 3% chance of spontaneous recovery without intervention or laryngeal EMG may not be the preferred option for some patients and their families.
MeSH term(s)	Child ; Humans ; Longitudinal Studies ; Quality of Life ; Retrospective Studies ; Vocal Cord Paralysis/surgery ; Vocal Cords
Language	English
Publishing date	2021-07-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	120642-4
ISSN	1943-572X ; 0003-4894
ISSN (online)	1943-572X
ISSN	0003-4894
DOI	10.1177/00034894211033366
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Article ; Online: Dysphagia in an 8-Year-Old Child.

Kemper, W Craig / Teplitzky, Taylor B / Brown, Ashley F / Mitchell, Ron B / Shah, Gopi B

Ear, nose, & throat journal

2022 , Page(s) 1455613221102866

Language	English
Publishing date	2022-05-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	750153-5
ISSN	1942-7522 ; 0145-5613
ISSN (online)	1942-7522
ISSN	0145-5613
DOI	10.1177/01455613221102866
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Article: Outcomes of Injection Laryngoplasty for Deep Interarytenoid Groove.

Mothersole, Kelsey H / Ulualp, Seckin O / Johnson, Romaine F / Brown, Ashley F / Shah, Gopi B / Liu, Christopher C / Chorney, Stephen R

International archives of otorhinolaryngology

2023 Volume 28, Issue 1, Page(s) e101–e106

Abstract: ... ...

Abstract	Introduction
Language	English
Publishing date	2023-10-06
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	2578584-9
ISSN	1809-4864 ; 1809-9777
ISSN (online)	1809-4864
ISSN	1809-9777
DOI	10.1055/s-0043-1767800
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Article ; Online: Survival After Declining Pediatric Tracheostomy Placement.

Liu, Palmila / Brooks, Rebecca L / Bailey, Candice H / Whitney, Cindy / Sewell, Ashley / Brown, Ashley F / Kou, Yann-Fuu / Johnson, Romaine F / Chorney, Stephen R

The Laryngoscope

2023 Volume 133, Issue 12, Page(s) 3602–3607

Abstract: Objective: To determine survival among critically ill children when caregivers decline tracheostomy placement.: Study design: Retrospective cohort.: Methods: All children (<18 years) obtaining a pre-tracheostomy consultation at a tertiary children' ...

Abstract	Objective: To determine survival among critically ill children when caregivers decline tracheostomy placement. Study design: Retrospective cohort. Methods: All children (<18 years) obtaining a pre-tracheostomy consultation at a tertiary children's hospital between 2016 and 2021 were included. Comorbidities and mortality were compared between children of caregivers that declined or agreed to tracheostomy. Results: Tracheostomy was declined for 58 children but was placed for 203 children. After consultation, mortality was 52% (30/58) when declining and 21% (42/230) when agreeing to tracheostomy (p < 0.001) at a mean of 10.7 months (standard deviation [SD]: 16) and 18.1 months (SD: 17.1), respectively (p = 0.07). For those declining, 31% (18/58) died during the hospitalization within a mean of 1.2 months (SD: 1.4) while 21% (12/58) died at a mean of 23.6 months (SD: 17.5) after discharge. Among children of caregivers declining tracheostomy, older age (odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.74-0.97, p = 0.01) and chronic lung disease (OR: 0.18, 95% CI: 0.04-0.82, P = .03) were associated with lower odds of mortality but sepsis (OR: 9.62, 95% CI: 1.161-57.43, p = 0.01) and intubation (OR: 4.98, 95% CI: 1.24-20.08, p = 0.02) were associated with higher odds of mortality. Median survival after declining tracheostomy was 31.9 months (interquartile range [IQR]: 2.0-50.7) and declining placement was associated with increased mortality risk (hazard ratio [HR]: 4.04, 95% CI: 2.49-6.55, p < 0.001). Conclusion: When caregivers declined tracheostomy placement, less than half of critically ill children in this cohort survived with younger age, sepsis, and intubation associated with higher mortality. This information offers valuable insight for families weighing decisions pertaining to pediatric tracheostomy placement. Level of evidence: 3 Laryngoscope, 133:3602-3607, 2023.
MeSH term(s)	Child ; Humans ; Retrospective Studies ; Tracheostomy ; Critical Illness ; Hospitalization ; Sepsis
Language	English
Publishing date	2023-04-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.30712
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Article: Outcomes of Injection Laryngoplasty for Deep Interarytenoid Groove

Mothersole, Kelsey H. / Ulualp, Seckin O. / Johnson, Romaine F. / Brown, Ashley F. / Shah, Gopi B. / Liu, Christopher C. / Chorney, Stephen R.

International Archives of Otorhinolaryngology

2023 Volume 28, Issue 01, Page(s) e101–e106

Abstract: Introduction: Deep interarytenoid groove (DIG) may cause swallowing dysfunction in children; however, the management of DIG has not been established.: Objective: We evaluated the subjective and objective outcomes of interarytenoid augmentation with ... ...

Abstract	Introduction: Deep interarytenoid groove (DIG) may cause swallowing dysfunction in children; however, the management of DIG has not been established. Objective: We evaluated the subjective and objective outcomes of interarytenoid augmentation with injection in children with DIG. Methods: Consecutive children under 18 years of age who underwent injection laryngoplasty for DIG were reviewed. Data pertaining to demographics, past medical history, past surgical history, and results of pre and postoperative video fluoroscopic swallow study (VFSS) were obtained. The primary outcome measure was the presence of thin liquid aspiration or penetration on postoperative VFSS. The secondary outcome measure was caregiver-reported improvement of symptoms. Results: Twenty-seven patients had VFSS before and after interarytenoid augmentation with injection (IA). Twenty (70%) had thin liquid penetration and 12 (44%) had thin liquid aspiration before the IA. Thin liquid aspiration resolved in 9 children (45%) and persisted in 11 (55%). Of the 12 children who had thin liquid aspiration prior to IA, 6 (50%) had resolution of thin liquid aspiration after IA. Conclusions: Injection laryngoplasty is a safe tool to improve swallowing function in children with DIG. Further studies are needed to assess the long-term outcomes of IA and identify predictors of successful IA in children with DIG.
Keywords	interarytenoid groove ; injection laryngoplasty ; children ; dysphagia ; endoscopic repair
Language	English
Publishing date	2023-10-06
Publisher	Thieme Revinter Publicações Ltda.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2578584-9
ISSN	1809-4864 ; 1809-9777 ; 1809-4864
ISSN (online)	1809-4864
ISSN	1809-9777 ; 1809-4864
DOI	10.1055/s-0043-1767800
Database	Thieme publisher's database

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Article ; Online: Pediatric Tracheostomy Outcomes After Development of a Multidisciplinary Airway Team: A Quality Improvement Initiative.

Chorney, Stephen R / Brown, Ashley F / Brooks, Rebecca L / Bailey, Candace / Whitney, Cindy / Sewell, Ashley / Johnson, Romaine F

OTO open

2021 Volume 5, Issue 3, Page(s) 2473974X211045615

Abstract: Objectives: To analyze a multidisciplinary tracheostomy team's effect on length of stay and cost.: Methods: An airway management program using a balanced scorecard was created to track key performance measures. Interventions included weekly rounding, ...

Abstract	Objectives: To analyze a multidisciplinary tracheostomy team's effect on length of stay and cost. Methods: An airway management program using a balanced scorecard was created to track key performance measures. Interventions included weekly rounding, standardized placement, postoperative care, and caregiver education. Process measures included time to first education, speech-language pathology consultation rates, and pretracheostomy consultations. Outcome measures focused on the total length of stay, 30-day revisit rates after discharge, accidental decannulation rate, and standardized cost. Regression analysis was used to predict the program's effect on length of stay and total cost. Results: In total, 239 children met inclusion. The mean time to first education class was reduced from 13.7 to 1.9 days ( Discussion: Establishing a multidisciplinary tracheostomy team results in improvements in quality metrics when caring for children with tracheostomies. Controlling for associated factors showed the mean length of stay decreased significantly in the first full year of program implementation. Cost analysis estimated significant reductions for tracheostomy patients spending less time in the hospital. Implications for practice: A airway management program can positively affect tracheostomy processes and outcomes.
Language	English
Publishing date	2021-09-30
Publishing country	United States
Document type	Journal Article
ISSN	2473-974X
ISSN (online)	2473-974X
DOI	10.1177/2473974X211045615
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Article ; Online: Caregiver quality of life after pediatric tracheostomy.

Wynings, Erin M / Chorney, Stephen R / Brooks, Rebecca L / Brown, Ashley F / Sewell, Ashley / Bailey, Candice H / Whitney, Cindy / Kou, Yann-Fuu / Johnson, Romaine F

International journal of pediatric otorhinolaryngology

2022 Volume 164, Page(s) 111416

Abstract: Objective: To determine the impact of a child with a tracheostomy on caregiver quality of life.: Methods: A repeated cross-sectional analysis included families with tracheostomy-dependent children between 2019 and 2021. Caregivers were surveyed using ...

Abstract	Objective: To determine the impact of a child with a tracheostomy on caregiver quality of life. Methods: A repeated cross-sectional analysis included families with tracheostomy-dependent children between 2019 and 2021. Caregivers were surveyed using the PedsQL™ Family Impact Module with assessments at tracheostomy placement and during ambulatory office visits. Results: Two-hundred and fifty-five surveys were performed with 66 at tracheostomy placement (26%) and 189 at follow-up visits (74%). Compared to families with healthy children, total scores at placement (77.2 vs. 87.6, P < .001) and follow-up visits (78.9 vs. 87.6, P < .001) were significantly lower among pediatric tracheostomy families. Caregivers were likely to report significant improvement in emotional functioning (6.2 points; 95% CI: 0.5-12, P = .03) and worry (9 points, 95% CI: 2.1-15.9, P = .01) over time. Demographic variables demonstrated no confounding or interactive effects. Conclusions: The presence of a tracheostomy is associated with lower caregiver quality of life scores in the short- and long-term compared to caregivers of healthy children. Providers should be sensitive to these challenges and provide appropriate support for families of tracheostomy-dependent children.
Language	English
Publishing date	2022-12-09
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	754501-0
ISSN	1872-8464 ; 0165-5876
ISSN (online)	1872-8464
ISSN	0165-5876
DOI	10.1016/j.ijporl.2022.111416
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Article ; Online: Accidental Tracheostomy Decannulations in Children-A Prospective Cohort Study of Inpatients.

Wynings, Erin M / Breslin, Nathaniel / Brooks, Rebecca L / Brown, Ashley F / Bailey, Candice H / Whitney, Cindy / Kou, Yann-Fuu / Johnson, Romaine F / Chorney, Stephen R

The Laryngoscope

2022 Volume 133, Issue 4, Page(s) 963–969

Abstract: Objectives: To determine the incidence of tracheostomy accidental decannulations (AD) among pediatric inpatients and identify risks for these events.: Study design: Prospective cohort.: Methods: All tracheostomy patients (≤18 years) admitted at a ... ...

Abstract	Objectives: To determine the incidence of tracheostomy accidental decannulations (AD) among pediatric inpatients and identify risks for these events. Study design: Prospective cohort. Methods: All tracheostomy patients (≤18 years) admitted at a tertiary children's hospital between August 2018 and April 2021 were included. AD were recorded and patient harm was classified as no harm/minor, moderate, or severe. Monthly AD incidence was described as events per 1000 tracheostomy-days. Results: One-hundred seventeen AD occurred among 67 children with 33% (22/67) experiencing multiple events (median: 2.5 events, range: 2-10). Mean age at AD was 4.7 years (SD: 4.4). AD resulted from patient movement (32%, 37/117), performing tracheostomy care (27%, 31/117), repositioning or transporting (15%, 17/117), or unclear reasons (27%, 32/117). A parent or guardian was involved in 28% (33/117) of events. Nearly all AD resulted in no more than minor harm (84%, 98/117) but moderate (12%, 14/117) and severe (4%, 5/117) events did occur. There were no deaths. Tracheostomy care or repositioning were frequently responsible in acute versus subacute events (48% vs. 26%, p = 0.04). Mean monthly AD incidence was 4.7 events per 1000 tracheostomy-days (95% CI: 3.7-5.8) and after implementation of safety initiatives, the mean rate decreased from 5.9 events (95% CI: 4.2-7.7) to 3.7 events (95% CI: 2.5-5.0) per 1000 tracheostomy-days (p = 0.04). Conclusions: AD in children occur at nearly 5 events per 1000 tracheostomy-days and often result in minimal harm. Quality initiatives targeting patient movement, provider education, and tracheostomy care might reduce the frequency of these complications. Level of evidence: 3 Laryngoscope, 133:963-969, 2023.
MeSH term(s)	Child ; Humans ; Child, Preschool ; Tracheostomy/adverse effects ; Tracheostomy/methods ; Prospective Studies ; Inpatients ; Device Removal/adverse effects ; Hospitalization ; Retrospective Studies
Language	English
Publishing date	2022-06-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.30250
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Article ; Online: Mortality Among Children with a Tracheostomy.

Teplitzky, Taylor B / Brown, Ashley F / Brooks, Rebecca L / Bailey, Candice H / Whitney, Cindy / Sewell, Ashley / Kou, Yann-Fuu / Johnson, Romaine F / Chorney, Stephen R

The Laryngoscope

2022 Volume 133, Issue 2, Page(s) 403–409

Abstract: Objectives: To characterize the cause of death among children with a tracheostomy.: Study design: Prospective cohort.: Methods: All pediatric patients (<18 years) who had a tracheostomy placed at a tertiary care institution between 2015 and 2020 ... ...

Abstract	Objectives: To characterize the cause of death among children with a tracheostomy. Study design: Prospective cohort. Methods: All pediatric patients (<18 years) who had a tracheostomy placed at a tertiary care institution between 2015 and 2020 were included. The location and cause of death were recorded along with patient demographics and age. Results: A total of 271 tracheostomies were placed with 46 mortalities reviewed for a mortality rate of 16.8%. Mean age at placement was 1.7 years (SD: 3.4) and mean age at death was 2.9 years (SD: 3.5). Most tracheostomies were placed for respiratory failure (N = 33, 72%). The mean time to death after tracheostomy was 1.2 years (SD: 1.2) and 28% (N = 13) occurred during the same admission as placement. Mean time to death after hospital discharge was 1.3 years (SD: 1.3). Etiology of death was respiratory failure (33%, N = 15), cardiopulmonary arrest (15%, N = 7), unknown (43%, N = 20), or secondary to a tracheostomy-related complication for 9% (N = 4). Location of death was in intensive care units for 41% (N = 19) and 30% died at home (N = 14). Comfort care measures were taken for 37% (N = 17). Severe neurological disability (HR: 4.06, p = 0.003, 95% CI: 1.59-10.34) and congenital heart disease (HR: 2.36, p = 0.009, 95% CI: 1.24-4.48) correlated with time to death on Cox proportional hazard modeling. Conclusions: Nearly one-third of children with a tracheostomy who expire will do so during the same admission as tracheostomy placement. Although progression of underlying disease will lead to most deaths, 9% will be a result of a tracheostomy-related complication, which represents a meaningful target for quality improvement initiatives. Level of evidence: 3 Laryngoscope, 133:403-409, 2023.
MeSH term(s)	Child ; Humans ; Child, Preschool ; Tracheostomy/adverse effects ; Prospective Studies ; Hospitalization ; Postoperative Complications ; Respiratory Insufficiency/surgery ; Retrospective Studies ; Hospital Mortality
Language	English
Publishing date	2022-03-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	80180-x
ISSN	1531-4995 ; 0023-852X
ISSN (online)	1531-4995
ISSN	0023-852X
DOI	10.1002/lary.30123
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