[Show abstract][Hide abstract]ABSTRACT: Contributing authors:
Isam Alobid, MD, PhD(1) , Nithin D. Adappa, MD(2) , Henry P. Barham, MD(3) , Thiago Bezerra, MD(4) , Nadieska Caballero, MD(5) , Eugene G. Chang, MD(6) , Gaurav Chawdhary, MD(7) , Philip Chen, MD(8) , John P. Dahl, MD, PhD(9) , Anthony Del Signore, MD(10) , Carrie Flanagan, MD(11) , Daniel N. Frank, PhD(12) , Kai Fruth, MD, PhD(13) , Anne Getz, MD(14) , Samuel Greig, MD(15) , Elisa A. Illing, MD(16) , David W. Jang, MD(17) , Yong Gi Jung, MD(18) , Sammy Khalili, MD, MSc(19) , Cristobal Langdon, MD(20) , Kent Lam, MD(21) , Stella Lee, MD(22) , Seth Lieberman, MD(23) , Patricia Loftus, MD(24) , Luis Macias-Valle, MD(25) , R. Peter Manes, MD(26) , Jill Mazza, MD(27) , Leandra Mfuna, MD(28) , David Morrissey, MD(29) , Sue Jean Mun, MD(30) , Jonathan B. Overdevest, MD, PhD(31) , Jayant M. Pinto, MD(32) , Jain Ravi, MD(33) , Douglas Reh, MD(34) , Peta L. Sacks, MD(35) , Michael H. Saste, MD(36) , John Schneider, MD, MA(37) , Ahmad R. Sedaghat, MD, PhD(38) , Zachary M. Soler, MD(39) , Neville Teo, MD(40) , Kota Wada, MD(41) , Kevin Welch, MD(42) , Troy D. Woodard, MD(43) , Alan Workman(44) , Yi Chen Zhao, MD(45) , David Zopf, MD(46) CONTRIBUTING AUTHOR AFFILIATIONS: (1) Universidad de Barcelona; (2) University of Pennsylvania; (3) Louisiana State University Health Sciences Center; (4) Universidade de São Paulo; (5) ENT Specialists of Illinois; (6) University of Arizona; (7) University of Oxford; (8) University of Texas; (9) University of Indiana; (10) Mount Sinai Beth Israel; (11) Emory University; (12) University of Colorado; (13) Wiesbaden, Germany; (14) University of Colorado; (15) University of Alberta; (16) University of Alabama at Birmingham; (17) Duke University; (18) Sungkyunkwan University; (19) University of Pennsylvania; (20) Universidad de Barcelona; (21) Northwestern University; (22) University of Pittsburgh; (23) New York University; (24) Emory University; (25) University of British Columbia; (26) Yale University School of Medicine; (27) Private Practice; (28) Department of Otolaryngology, Hôtel-Dieu Hospital, Centre de Recherche du Centre Hospitalier de l'Université de Montréal; (29) University of Adelaide; (30) Pusan National University; (31) University of California, San Francisco; (32) University of Chicago; (33) University of Auckland; (34) Johns Hopkins University; (35) University of New South Wales, Australia; (36) Stanford University; (37) Washington University; (38) Harvard Medical School; (39) Medical University of South Carolina; (40) Singapore General Hospital; (41) Taho University; (42) Northwestern University; (43) Cleveland Clinic Foundation; (44) University of Pennsylvania; (45) University of Adelaide; (46) University of Michigan.
Full-text · Article · Feb 2016 · International Forum of Allergy and Rhinology
[Show abstract][Hide abstract]ABSTRACT: Importance
Pediatric adenotonsillectomy is one of the most frequently performed procedures in the United States. Whereas several studies have focused on tonsillectomy techniques and outcomes, little is known about the overall changes in the distribution of care. Variations in care patterns between academic and nonacademic settings may have important financial and educational effects.Objective
To determine whether regionalization of inpatient pediatric adenotonsillectomy has occurred over the past decade with respect to hospital teaching status and primary expected payer.Design, Setting, and Participants
Secondary analysis of all inpatient admissions following pediatric adenotonsillectomy (age <18 years) in the Nationwide Inpatient Sample during the calendar years 2000, 2005, and 2010.Exposure
Inpatient pediatric tonsillectomy.Main Outcomes and Measures
The percentage distributions of pediatric adenotonsillectomies with respect to hospital teaching status and primary payer were compared according to calendar year to determine temporal changes. Multivariate analysis was conducted with logistic regression to determine year-to-year changes in the proportion of pediatric adenotonsillectomy admissions, controlling for hospital teaching status and expected source of payment.Results
The estimated numbers of inpatient hospital pediatric adenotonsillectomy stays in the United States in 2000, 2005, and 2010 were 12 879 (SE, 1695), 17 245 (SE, 2276), and 13 732 (SE, 2082), respectively. There was a significant increase in the proportion of children admitted to academic hospitals from 60.1% to 69.8% to 78.6%, respectively (P = .045). With respect to teaching hospitals, the primary expected payer distribution shifted significantly, with an increase in Medicaid recipients from 38.4% to 38.9% to 50.5%, and a decline in private insurance from 57.7% to 51.5% to 43.9% (P = .02).Conclusions and Relevance
Inpatient pediatric adenotonsillectomies are increasingly being regionalized to academic/teaching hospitals. Concurrently, the proportion of patients using Medicaid as the primary payer has increased for inpatient tonsillectomies in teaching hospitals. Such regionalization has important implications for health care reimbursement and distribution of care.
No preview · Article · Dec 2015 · JAMA Otolaryngology - Head and Neck Surgery
[Show abstract][Hide abstract]ABSTRACT: Background: Prostaglandin (PG) D2 is the dominant COX product of mast cells and is an effector of aspirin-induced respiratory reactions in patients with aspirin-exacerbated respiratory disease (AERD). Objective: We evaluated the role of the innate cytokine thymic stromal lymphopoietin (TSLP) acting on mast cells to generate PGD2 and facilitate tissue eosinophilia and nasal polyposis in patients with AERD. Methods: Urinary eicosanoid levels were measured in aspirin-tolerant control subjects and patients with AERD. Nasal polyp specimens from patients with AERD and chronic rhinosinusitis were analyzed by using quantitative PCR, Western blotting, and immunohistochemistry. Human cord blood-and peripheral blood-derived mast cells were stimulated with TSLP in vitro to assess PGD2 generation. Results: Urinary levels of a stable PGD2 metabolite (uPGD-M) were 2-fold higher in patients with AERD relative to those in control subjects and increased further during aspirin-induced reactions. Peak uPGD-M levels during aspirin reactions correlated with reductions in blood eosinophil counts and lung function and increases in nasal congestion. Mast cells sorted from nasal polyps expressed PGD2 synthase (hematopoietic PGD2 synthase) mRNA at higher levels than did eosinophils from the same tissue. Whole nasal polyp TSLP mRNA expression correlated strongly with mRNA encoding hematopoietic PGD2 synthase (r = .75), the mast cell-specific marker carboxypeptidase A3 (r = .74), and uPGD-M (r = 0.74). Levels of the cleaved active form of TSLP were increased in nasal polyps from patients with AERD relative to those in aspirin-tolerant control subjects. Recombinant TSLP induced PGD2 generation by cultured human mast cells. Conclusions: Our study demonstrates that mast cell-derived PGD2 is a major effector of type 2 immune responses driven by TSLP and suggests that dysregulation of this innate system contributes significantly to the pathophysiology of AERD.
No preview · Article · Dec 2015 · The Journal of allergy and clinical immunology
[Show abstract][Hide abstract]ABSTRACT: Objective:
Develop normative data for adult sleep duration and determine if nonstandard sleep time relates to the likelihood of accidental injury.
National health information database.
The National Health Interview Survey, 2004-2013, was examined for adult sleep time and accidental injury within the past 3 months. The mean hours slept per night was determined. The relationship between sleep time and incidence of accidental injury was determined for any injury, injury while driving, and injury while working, adjusting for demographic variables.
Among 221.4 million adults (raw sample, N = 282,692), the mean sleep time was 7.17 hours (95% confidence interval [95% CI], 7.16-7.18 hours). Men and women slept very similar times (7.14 vs 7.17 hours, respectively), and sleep time decreased until the fifth decade (minimum, 6.99 hours), increasing each decade thereafter; 2.81% of adults reported being accidentally injured in the preceding 3 months. Too little sleep and excessive sleep times were both associated with higher rates of accidental injury (odds ratio per hour of deviation from mean, 1.16 [95% CI, 1.12-1.19]), adjusting for age, sex, marital status, and education level. Similar increased odds ratios were noted for injury while driving (1.11 [95% CI, 1.01-1.22]) and injury while at work (1.12 [95% CI, 1.04-1.20]) with sleep time deviation.
Most adults sleep between 7 and 8 hours nightly. Adults with sleep time outside this range, with either less or more sleep, have increased rates of accidental injury. These data highlight the need for sufficient quantity and quality of sleep in preventing accidental injury.
No preview · Article · Sep 2015 · Otolaryngology Head and Neck Surgery
[Show abstract][Hide abstract]ABSTRACT: Direct laryngoscopy, once an inpatient procedure, is now commonly performed in the outpatient setting. To ensure that safety follows the adoption of novel techniques and practice patterns, it is important to analyze the complication and revisit rates of these ambulatory surgery practices.
To determine revisit rates and complications after ambulatory adult direct laryngoscopy procedures.
This was a retrospective cross-sectional analysis of cases of adult patients who had undergone a direct laryngoscopic procedure extracted from multistate ambulatory surgery and hospital databases (State Ambulatory Surgery Databases for New York, Florida, Iowa, and California for 2010 and 2011). The analysis was performed on December 1, 2014. Index cases were linked to the corresponding State Emergency Department Databases and the State Inpatient Databases for visit encounters occurring within a 7-day postoperative window. All index cases were ambulatory surgery, without overnight stay or 23-hour observation.
Adult patients who had undergone a direct laryngoscopy procedure.
Direct laryngoscopy performed in an ambulatory setting. Patients who underwent flexible laryngoscopy, lesion destruction, laryngectomy, cordectomy, or a secondary nonlaryngoscopy procedure were specifically excluded.
Data regarding sex, age, revisit occurrence with associated complications, and mortality were analyzed.
A total of 7743 cases of ambulatory laryngoscopy were identified (mean age, 60.4 years; 61% were male). The 7-day revisit rate was 3.0% (232 revisits). Serious airway complications occurred in 0.27% of cases (n = 21) and accounted for 9.1% of revisits. The rates of other major complications and minor complications were 0.15% (n = 12) and 0.75% (n = 58), respectively. There were no cases of anoxic brain injury. Two deaths occurred at the time of the revisit (7-day mortality rate, 0.03%; 95% CI, 0.01%-0.09%).
Adult ambulatory direct laryngoscopy has a favorable safety profile. Serious airway complications occur in fewer than 3 patients per 1000 cases. The risk of death following outpatient laryngoscopy is extremely low. Outpatient laryngoscopy is not universally suited for all patients, and careful preoperative selection and counseling are imperative.
No preview · Article · Jul 2015 · JAMA Otolaryngology - Head and Neck Surgery
[Show abstract][Hide abstract]ABSTRACT: Recurrent, rapidly growing nasal polyps are hallmarks of aspirin-exacerbated respiratory disease (AERD), though the mechanisms of polyp growth have not been identified. Fibroblasts are intimately involved in tissue remodeling, and the growth of fibroblasts is suppressed by prostaglandin E2 (PGE2), which elicits antiproliferative effects mediated through the E Prostanoid (EP)2 receptor. We now report that cultured fibroblasts from the nasal polyps of subjects with AERD resist this antiproliferative effect. Fibroblasts from polyps of AERD subjects resisted the antiproliferative actions of PGE2 and a selective EP2 agonist (P<0.0001 at 1µM) compared with nasal fibroblasts from aspirin tolerant control subjects undergoing polypectomy or from healthy control subjects undergoing concha bullosa resections. Cell surface expression of the EP2 receptor protein was lower in fibroblasts from AERD subjects than in fibroblasts from healthy controls and aspirin-tolerant subjects (P<0.01 for both). Treatment of the fibroblasts with trichostatin A (TSA), a histone deacetylase inhibitor, significantly increased EP2 receptor mRNA in fibroblasts from AERD and aspirin-tolerant subjects, but had no effect on COX-2, EP4 and mPGES1 mRNA levels. Histone acetylation (H3K27ac) at the EP2 promoter correlated strongly with baseline EP2 mRNA (r=0.80, P<0.01). These studies suggest that the EP2 promotor is under epigenetic control and one explanation for PGE2 resistance in AERD is an epigenetically mediated reduction of EP2 receptor expression which could contribute to the refractory nasal polyposis typically observed in this syndrome.
Full-text · Article · Jun 2015 · American Journal of Respiratory Cell and Molecular Biology
[Show abstract][Hide abstract]ABSTRACT: Objectives/HypothesisDetermine rates and reasons for revisits after adult uvulopalatopharyngoplasty (UPPP).Study DesignCross-sectional analysis of multistate ambulatory surgery and hospital databases.Methods
Ambulatory adult UPPP cases were extracted from the State Ambulatory Surgery Databases for New York, Florida, Iowa, and California for 2010. Cases were linked to the State Emergency Department Databases and the State Inpatient Databases for visit encounters occurring 0 to 14 days after the procedure. The number of revisits (including readmissions) was determined as well as the diagnosis at the revisit. The overall mortality rate and intervention rate for postprocedural bleeding were determined.ResultsA total of 2,349 ambulatory UPPP cases were extracted (mean age, 44.9 years). Overall, 9.7% of patients had a revisit after surgery (13.7% revisited the ambulatory surgery center, 68.3% the emergency department. and 18.1% to inpatient admission). The primary diagnoses at the first revisit were bleeding (38.3%), acute pain (21.2%), and fever/dehydration (6.6%). Overall, 1.6% of patients incurred a second revisit. Among all cases, 3.7% and 0.6% presented with a bleeding diagnosis at a first and second revisit, respectively. Among revisits, 11.5% and 26.3% underwent a procedure to control bleeding at the first and second revisits, respectively. One death occurred for an overall 14-day mortality rate of 0.043%.Conclusions
Ambulatory UPPP demonstrates an good postoperative safety profile. Postoperative hemorrhage and acute pain, as well as fever/dehydration, are common reasons for revisits. These particular complications should be targeted for prevention to reduce postoperative revisit rates.Level of Evidence2b Laryngoscope, 125:754-757, 2015
No preview · Article · Mar 2015 · The Laryngoscope
[Show abstract][Hide abstract]ABSTRACT: Investigate the incidence and characteristics of revisits following ambulatory pediatric tonsillectomy/adenotonsillectomy. Cross-sectional study using national databases. Ambulatory pediatric (age <18.0 years) tonsillectomy or adenotonsillectomy cases were extracted from the 2010 State Ambulatory Surgery, Emergency Department, and Inpatient databases for New York, Florida, Iowa, and California. First and second revisits within the 14-day postoperative period were tabulated. Diagnoses, procedure codes, and mortality were examined. There were 36,221 pediatric tonsillectomies/adenotonsillectomies (mean age 7.4 years, 51.4% male). Overall, 2,740 patients (7.6%) had a revisit after pediatric tonsillectomy; 402 patients (1.1%) had a second revisit. Among revisits, 6.3% revisited the ambulatory surgery center, 77.5% revisited the emergency department, and 16.2% were readmitted as an inpatient. Among all tonsillectomies, bleeding occurred in 2.0% and 0.5% within the first and second revisits, respectively. A second revisit had a statistically higher association with a primary bleeding diagnosis than the first revisit (P < .001). Among all cases, 0.75% underwent a surgical procedure for bleeding at a first revisit compared to 0.25% during a second revisit. Acute pain was the primary diagnosis in 18.4% and 11.2% of first and second revisits; fever/vomiting/dehydration were primary diagnoses in 28.2% and 17.9%, respectively. There were two mortalities (0.0055%) within the 14-day postoperative interval. This large-scale analysis describes the current rates and diagnoses of revisits, hospital readmission, and surgical intervention following ambulatory pediatric tonsillectomy. Many revisits centered on pain control and dehydration, suggesting that more adequate symptom control may prevent a large proportion of revisits. 2b. Laryngoscope, 125:457–461, 2015
No preview · Article · Feb 2015 · The Laryngoscope
[Show abstract][Hide abstract]ABSTRACT: The care of patients with head and neck cancer (HNCA) is becoming increasingly regionalized to high-volume, more effective centers. However, it remains uncertain whether such care is equally distributed. Increasing our understanding of how HNCA treatment is utilized among different sectors should improve strategy designs aimed at ensuring optimized quality of care.
To determine which patient- or treatment-associated factors may account for increased regionalization of HNCA care.
Secondary analysis of all inpatient records of hospital admissions with a primary HNCA diagnosis contained within the Nationwide Inpatient Sample during the calendar years 2000, 2005, and 2010.
Influence of comorbidities, payer, radiation therapy, and case complexity on regionalization of HNCA care to teaching institutions.
In the years 2000, 2005, and 2010, there were an estimated mean (SE) 28 862 (2067), 33 517 (3080), and 37 354 (4194) inpatient hospital HNCA stays, respectively, in the United States. Over time, the respective Charlson comorbidity index (CCI) scores (4.4 and 4.0) and Van Walraven scores (10.0 and 8.9) for nonteaching and teaching institutions were increasingly higher (P < .001). Payer status (private insurance vs Medicaid) did not change for teaching institutions (35.4% vs 33.3%) (P ≥ .63), but the proportion of Medicaid patients did increase over time for nonteaching institutions (10.2% vs 15.8%) (P = .002). Both teaching and nonteaching institutions saw an increase in proportion of prior irradiated cases (7.6% and 4.6% vs 3.4% and 1.9%, respectively) (P ≤ .02). The proportion of major ablative procedures was stable for teaching institutions over time (46.5% vs 43.3%) (P = .57) but decreased for nonteaching institutions (27.2% vs 32.6%) (P = .01). The proportion of flap reconstruction procedures increased over time for teaching institutions (8.6% vs 4.1%) (P < .001) but not for nonteaching institutions (2.7% vs 2.4%) (P = .21).
Despite the demonstrated link between excellence and outcomes and specialized resource-intensive care, the regionalization of head and neck oncologic treatment is becoming increasingly divergent, and the neediest, sickest patient groups are receiving less than optimal care.
No preview · Article · Jan 2015 · JAMA Otolaryngology - Head and Neck Surgery
[Show abstract][Hide abstract]ABSTRACT: Objectives/HypothesisQuantify the relationships between dizziness, falls, and obesity among adults. Study DesignCross-sectional analysis of a national health survey. Methods
Adult respondents in the 2008 National Health Interview Survey balance module were analyzed. With demographic information, data for balance and dizziness problems, reported falls, injuries from falls, and body mass index were extracted. Associations between balance/dizziness problems and falls or injuries from falls were determined. The additional association between obesity and falls or fall-related injuries in the setting of a balance/dizziness problem was determined. ResultsAmong 216.83.5 million adult Americans, 24.20.7 million reported dizziness in the past 12 months (11.1%+/- 0.3%; mean age, 45.9 +/- 0.2 years; 51.7%+/- 0.5% female), 11.5%+/- 0.3% had fallen in the prior 12 months, and 26.3%+/- 0.4% were obese. Among individuals reporting dizziness, 34.3%+/- 1.3% reported falls, whereas only 9.1%+/- 0.3% of nondizzy individuals reported a fall (odds ratio [OR]: 5.1; P<.001). Among dizzy individuals who reported a fall, 45.8%+/- 2.1% were injured by the fall versus 35.6%+/- 1.4% nondizzy individuals who fell (OR: 1.5; P<.001). The addition of obesity to dizziness increased the odds of falling by 1.3 (95% confidence interval: 1.2-1.5; P<.001) but did not significantly increase the odds of fall-related injury (P=.110). Conclusions
Dizziness/balance problems are strongly associated with both an increased tendency to fall and increased injury rate from falls among adults. The addition of obesity to dizziness was associated with a higher rate of falling but was not associated with a significantly higher rate of fall-related injury. Balance problems in conjunction with obesity need to be targeted in fall-prevention efforts. Level of Evidence2b. Laryngoscope, 124:2797-2801, 2014
No preview · Article · Dec 2014 · The Laryngoscope
[Show abstract][Hide abstract]ABSTRACT: Determine if disparities exist for revisit complications after adult tonsillectomy.Methods
Cases of adult tonsillectomy were extracted from the state ambulatory surgery databases and linked to the state emergency department databases and inpatient databases for California, Iowa, Florida and New York for 2010 and 2011. Revisits within 14 days for diagnoses of: post-tonsillectomy bleeding, acute pain and nausea/vomiting/dehydration were determined and analyzed for associations of these complications with age, sex, race, median household income and comorbidity score.ResultsAmong 17,836 tonsillectomies (63.7% female; mean age, 29.0 years), revisit rates for post-tonsillectomy bleeding, acute pain and fever/dehydration were 5.1%, 2.8% and 1.5%, respectively. On multivariate analysis, only female sex was associated with a lower post-tonsillectomy bleeding rate (odds, 0.48, p < 0.001). Decreasing household income, female sex, black and Hispanic race were associated with increased revisits for acute pain (odds, 1.21, 1.49, 2.03 and 1.32, p ≤ 0.002). Female sex was associated with an increased odds of a revisit for FNVD (odds, 1.94, p < 0.001).Conclusions
Significant disparities with respect to income and race exist in the incidence of revisits and potentially avoidable complications after adult tonsillectomy.
No preview · Article · Nov 2014 · American Journal of Otolaryngology
[Show abstract][Hide abstract]ABSTRACT: Objectives/HypothesisDetermine the prevalence of smell disturbance and taste disturbance and associated factors in adults.Study DesignCross-sectional analysis of nationwide household health survey.Methods
Data from the taste and smell disorders component of the National Health and Nutrition Examination Survey (NHANES) 2011 to 2012 were examined. The prevalence of self-reported problems with taste and/or smell among adults and the associated symptom frequency, related healthcare provider interactions, and symptoms/etiologies (e.g., persistent cold/flu, dry mouth, or head injury, etc.) were determined. Associations between sex and age with smell and taste disturbances as well as the relationship between smell and taste disturbances were determined.ResultsAmong 142.5 ± 12.6 million adult Americans (raw N = 3,594), there were an estimated 15.1 ± 2.1 million individuals (10.6% ± 1.0%) with self-reported smell disturbance in the prior 12 months. Sex was not associated with the prevalence of self-reported smell disturbance (P = 0.146), but increasing age was associated with an increasing prevalence of smell disturbance (odds ratio [OR] 1.147; 95% confidence interval [CI], 1.003–1.312). An estimated 7.5 ± 0.6 million individuals (5.3% ± 0.3%) reporting a problem with taste in the prior 12 months. Sex was not associated with the prevalence of taste disturbance (P = 0.947) but increasing age was (OR 1.202; 1.037–1.395). Among 19.4 ± 2.2 million reporting smell and/or taste abnormality, 20.2% ± 2.3% discussed this with a healthcare provider and 5.8% ± 1.4% felt it interfered with their daily life.ConclusionA significant number of adult Americans report problems with smell disturbance and taste disturbance. Further work to identify patients whose smell or taste disturbance can be helped is warranted.Level of Evidence2b. Laryngoscope, 2014
No preview · Article · Nov 2014 · The Laryngoscope
[Show abstract][Hide abstract]ABSTRACT: Objectives/HypothesisForeign body aspiration (FBA) continues to be a concerning pediatric problem, accounting for thousands of emergency room visits and more than 100 deaths each year in the United States. The costs incurred with hospitalizations and procedures following these events are the focus of this study.Study DesignRetrospective review.Methods
The Nationwide Inpatient Sample from 2009 to 2011 was analyzed, and all cases with pediatric bronchial foreign body aspirations (International Classification of Diseases-9 codes: 934.0, 934.1, 934.8, and 934.9) were reviewed. Cases were analyzed to determine type of foreign body aspiration, procedural interventions performed, duration of inpatient stay, mortality rate, complications, and posthospitalization disposition. The median length of hospital stay and total costs associated with aspiration events were determined.ResultsAn estimated 1,908 ± 273 pediatric bronchial FBA patients were admitted annually over the 3-year period (mean age, 3.6 ± 0.3 years; 61.3% ± 1.9% male). The ratio of foreign object aspiration to food aspiration was 5:3. Overall, 56%.0 ± 3.6% of the patients underwent a bronchoscopic procedure for foreign body removal; of those, 41.5% ± 2.5% had a foreign body removed at the time of the endoscopy. The hospital mortality rate associated with bronchial aspiration was 1.8% ± 0.4%; and 2.2% ± 0.5% of patients were diagnosed with anoxic brain injury. The median length of stay was 3 days (25th–75th interquartile range, 1–7 days).The median charges and actual costs per case were $20,820 ($10,800–$53,453) and $6,720 ($3,628–$16,723), respectively.Conclusion
The annual overall inpatient cost associated with pediatric bronchial foreign-body aspiration is approximately $12.8 million. Combined, the rate of death or anoxic brain injury associated with pediatric foreign body is approximately 4%.Level of Evidence2C. Laryngoscope, 2014
No preview · Article · Oct 2014 · The Laryngoscope