Abstract

The presence of an anterior mediastinal mass should prompt rapid triage, workup and treatment to effectively manage and prevent emergent complications. Implementation of an AMM protocol can ensure the response is standardized and coordinated. Importantly, such a protocol can encourage prompt multi-disciplinary communication to mitigate risks associated with procedures required for timely diagnosis. The aim of this review is to evaluate the BC Children’s Hospital’s Pediatric New/Suspected Anterior Mediastinal Mass (AMM) Protocol. Retrospective chart review was conducted for 18 patients admitted from February 2016 to May 2020 with AMM for whom the protocol was enacted. Primary parameters assessed presence of high-risk feature at time of presentation, time from admission and/or protocol activation to specific time points, including imaging, first diagnostic procedure, and diagnosis. Data regarding perioperative management, including anesthetic considerations and peri-operative complications, was also collected. Mean time from protocol activation to first diagnostic procedure and diagnosis were 1.88 days (range 0–7) and 2.24 days (range 0–7), respectively. The majority of procedures were conducted under sedation (n = 77, 64%), followed by general anesthetic (GA; n = 34, 28%) and local anesthetic (n = 10, 8%). Despite 15 cases having more than one high risk feature, pre-operative steroids were only administered for four of the total 158 procedures (3%) and extracorporeal life support (ECLS) and otolaryngology (ENT) were only required for immediate availability for seven procedures (4%). Furthermore, only 10 procedures (8%) had associated complications and none of these complications resulted in patient death. Our data demonstrate that implementation of a streamlined multi-disciplinary protocol can expedite time to diagnosis without impacting patient safety.

摘要

前纵隔肿块的存在应促使快速分诊、检查和治疗，以有效管理和预防紧急并发症。AMM 协议的实施可以确保响应的标准化和协调性。重要的是，这样的协议可以鼓励及时的多学科交流，以减轻与及时诊断所需程序相关的风险。本次审查的目的是评估 BC 儿童医院的儿科新/疑似前纵隔肿块 (AMM) 协议。对 2016 年 2 月至 2020 年 5 月入院的 18 名 AMM 患者进行了回顾性图表审查，并为其制定了方案。主要参数评估在出现时、从入院和/或协议激活到特定时间点的时间是否存在高风险特征，包括影像学、第一次诊断程序和诊断。还收集了有关围手术期管理的数据，包括麻醉注意事项和围手术期并发症。从协议激活到首次诊断程序和诊断的平均时间分别为 1.88 天（范围 0-7）和 2.24 天（范围 0-7）。大多数程序是在镇静下进行的（n  = 77, 64%)，其次是全身麻醉 (GA; n  = 34, 28%) 和局部麻醉 ( n  = 10, 8%)。尽管有 15 例具有不止一种高风险特征，但在总共 158 例手术中只有四例 (3%) 进行了术前类固醇治疗，并且只有七例手术才需要体外生命支持 (ECLS) 和耳鼻喉科 (ENT) 才能立即使用(4%)。此外，只有 10 次手术 (8%) 有相关并发症，而且这些并发症均未导致患者死亡。我们的数据表明，实施简化的多学科协议可以在不影响患者安全的情况下加快诊断时间。