A new investigation has found that rates of physical trauma following operative vaginal delivery (OVD) in Canada are higher than previously reported.

The cohort study of more than 1.3 million deliveries in the country found trauma rates were highest with forceps delivery, with more than 1 in 4 pregnancies resulting in maternal trauma and 1 in 105 infants experiencing neonatal trauma. Maternal and neonatal trauma following vacuum deliveries was less common, occurring in 1 in 8 pregnancies and 1 in 104 infants, according to the researchers, who reported their findings in the Canadian Medical Association Journal .

“The rates of trauma following OVD in Canada are higher than previously reported, irrespective of region, level of obstetric care, and volume of instrument use among hospitals,” lead author Giulia Muraca, PhD, MPH, assistant professor of obstetrics and gynecology at McMaster University, Hamilton, Ont., said in an interview. “While OVDs may be associated with low rates of morbidity in carefully selected circumstances, the uniformly high rates of trauma among forceps and vacuum deliveries documented across regions, levels of obstetric care, and hospitals show that such conditions do not apply to routine obstetric practice in Canada.”

The American College of Obstetricians and Gynecologists considers OVD a way to reduce the rate of cesarean deliveries. However, the group has also pointed to a decline in familiarity with the procedures among clinicians new to the field.

Current reports also show that while OVD accounts for up to 15% of deliveries in Canada, Australia, and the United Kingdom, the risks associated with the approach are heavily dependent on the expertise of the provider. Declining use of OVD in favor of cesarean delivery has reduced opportunities for clinicians to acquire proficiency in performing these deliveries, according to the researchers.

Given these various factors, the investigators said the consensus on the safety of OVD is under scrutiny.

“An examination of maternal and neonatal trauma among OVD in contemporary practice is necessary to ensure that health care providers, policy makers, and pregnant individuals are informed regarding the risks of OVD typically experienced in routine obstetric practice, rather than those encountered under ideal conditions,” Dr. Muraca said.
 

Over 1 million deliveries studied

Dr. Muraca and colleagues looked at 1,326,191 deliveries occurring across Canada (except Quebec) between April 2013 and March 2019. The researchers included all singleton, term (≥37 weeks), in-hospital deliveries to women who had not undergone a previous cesarean delivery.

The study’s primary outcome measures were composite maternal trauma and composite neonatal trauma. Maternal trauma included obstetric anal sphincter injury (OASI); cervical or high vaginal laceration; pelvic hematoma; obstetric injury to the pelvic organs, pelvic joints, or ligaments; injury to the bladder or urethra; and other pelvic trauma. Neonatal trauma comprised intracranial hemorrhage and laceration, skull fracture, severe injury to the central or peripheral nervous system, fracture of the long bones, injury to the liver or spleen, seizures, and neonatal death.

The analysis found that 38,500 (2.9%) of the cases involved attempted forceps deliveries while 110,987 (8.4%) were attempted vacuum deliveries. Of the attempted forceps deliveries, 1,606 (4.2%) failed, while 8,791 (7.9%) of attempted vacuum deliveries failed.

Maternal trauma was observed in 25.3% of all forceps deliveries (n = 9,728) and 13.2% of all vacuum deliveries (n = 14,614), the researchers reported. The most common form of maternal trauma was OASI, which was observed in 21.52% of women undergoing forceps delivery and 11.67% of those undergoing vacuum delivery. The rates of all other forms of maternal trauma were higher among patients undergoing attempted forceps delivery than among their counterparts undergoing attempted vacuum delivery.

After adjusting for possible confounders, rates of maternal trauma remained higher with forceps than with vacuum deliveries (adjusted rate ratio, 1.70).

The rate of neonatal trauma was comparable for forceps (9.56/1,000 live births) and vacuum deliveries (9.58/1,000 live births). In these cases, damage to the peripheral nervous system was the most common form of neonatal trauma, occurring in 4.85/1,000 live births with forceps delivery and 3.41/1,000 live births for vacuum delivery, the researchers found.
 

Consider morbidity following OVD against potential alternatives, authors say

According to Dr. Muraca, the rates of maternal trauma in her study – along with accumulating evidence of the severe long-term consequences of these injuries – demonstrates the importance of reporting timely, empirically derived risk measures that accurately reflect those that pregnant individuals may encounter in typical obstetric practice.

“Although there is merit in understanding the estimates of risk that can be achieved when conditions are optimal, the interpretation of these estimates can be misleading, especially given secular shifts in patterns of practice,” she said. “The failure to do so compromises women’s autonomy in making evidence-informed decisions regarding childbirth interventions, such as evaluating the short- and long-term risks of OVD and cesarean delivery.

Her group recommended that morbidity following OVD be weighed against potential alternatives to such procedures, which carry their own risks. “This includes an extended second stage of labor and a spontaneous vaginal delivery, or a second-stage cesarean delivery, both of which are associated with significant morbidity,” Dr. Muraca said. “However, a comprehensive consideration of high population rates of OVD morbidity also prompts questions about choice of instrument, obstetrician training in OVD use, and for recognizing cases that would benefit from a cesarean delivery earlier in labor.”

Alan Peaceman, MD, professor of obstetrics and gynecology at Northwestern University, Chicago, said he was not surprised by the rates of sphincter injury, but that the rate of severe neonatal injury rate was higher than he expected. However, he added, “I don’t think clinicians should change their approach based on a single study. They should continue with the approach that they are most skilled at and is appropriate for the clinical circumstances.”

The study was funded by a grant from the Canadian Institutes of Health Research. Dr. Muraca and Dr. Peaceman have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

A new investigation has found that rates of physical trauma following operative vaginal delivery (OVD) in Canada are higher than previously reported.

The cohort study of more than 1.3 million deliveries in the country found trauma rates were highest with forceps delivery, with more than 1 in 4 pregnancies resulting in maternal trauma and 1 in 105 infants experiencing neonatal trauma. Maternal and neonatal trauma following vacuum deliveries was less common, occurring in 1 in 8 pregnancies and 1 in 104 infants, according to the researchers, who reported their findings in the Canadian Medical Association Journal .

“The rates of trauma following OVD in Canada are higher than previously reported, irrespective of region, level of obstetric care, and volume of instrument use among hospitals,” lead author Giulia Muraca, PhD, MPH, assistant professor of obstetrics and gynecology at McMaster University, Hamilton, Ont., said in an interview. “While OVDs may be associated with low rates of morbidity in carefully selected circumstances, the uniformly high rates of trauma among forceps and vacuum deliveries documented across regions, levels of obstetric care, and hospitals show that such conditions do not apply to routine obstetric practice in Canada.”

The American College of Obstetricians and Gynecologists considers OVD a way to reduce the rate of cesarean deliveries. However, the group has also pointed to a decline in familiarity with the procedures among clinicians new to the field.

Current reports also show that while OVD accounts for up to 15% of deliveries in Canada, Australia, and the United Kingdom, the risks associated with the approach are heavily dependent on the expertise of the provider. Declining use of OVD in favor of cesarean delivery has reduced opportunities for clinicians to acquire proficiency in performing these deliveries, according to the researchers.

Given these various factors, the investigators said the consensus on the safety of OVD is under scrutiny.

“An examination of maternal and neonatal trauma among OVD in contemporary practice is necessary to ensure that health care providers, policy makers, and pregnant individuals are informed regarding the risks of OVD typically experienced in routine obstetric practice, rather than those encountered under ideal conditions,” Dr. Muraca said.
 

Over 1 million deliveries studied

Dr. Muraca and colleagues looked at 1,326,191 deliveries occurring across Canada (except Quebec) between April 2013 and March 2019. The researchers included all singleton, term (≥37 weeks), in-hospital deliveries to women who had not undergone a previous cesarean delivery.

The study’s primary outcome measures were composite maternal trauma and composite neonatal trauma. Maternal trauma included obstetric anal sphincter injury (OASI); cervical or high vaginal laceration; pelvic hematoma; obstetric injury to the pelvic organs, pelvic joints, or ligaments; injury to the bladder or urethra; and other pelvic trauma. Neonatal trauma comprised intracranial hemorrhage and laceration, skull fracture, severe injury to the central or peripheral nervous system, fracture of the long bones, injury to the liver or spleen, seizures, and neonatal death.

The analysis found that 38,500 (2.9%) of the cases involved attempted forceps deliveries while 110,987 (8.4%) were attempted vacuum deliveries. Of the attempted forceps deliveries, 1,606 (4.2%) failed, while 8,791 (7.9%) of attempted vacuum deliveries failed.

Maternal trauma was observed in 25.3% of all forceps deliveries (n = 9,728) and 13.2% of all vacuum deliveries (n = 14,614), the researchers reported. The most common form of maternal trauma was OASI, which was observed in 21.52% of women undergoing forceps delivery and 11.67% of those undergoing vacuum delivery. The rates of all other forms of maternal trauma were higher among patients undergoing attempted forceps delivery than among their counterparts undergoing attempted vacuum delivery.

After adjusting for possible confounders, rates of maternal trauma remained higher with forceps than with vacuum deliveries (adjusted rate ratio, 1.70).

The rate of neonatal trauma was comparable for forceps (9.56/1,000 live births) and vacuum deliveries (9.58/1,000 live births). In these cases, damage to the peripheral nervous system was the most common form of neonatal trauma, occurring in 4.85/1,000 live births with forceps delivery and 3.41/1,000 live births for vacuum delivery, the researchers found.
 

Consider morbidity following OVD against potential alternatives, authors say

According to Dr. Muraca, the rates of maternal trauma in her study – along with accumulating evidence of the severe long-term consequences of these injuries – demonstrates the importance of reporting timely, empirically derived risk measures that accurately reflect those that pregnant individuals may encounter in typical obstetric practice.

“Although there is merit in understanding the estimates of risk that can be achieved when conditions are optimal, the interpretation of these estimates can be misleading, especially given secular shifts in patterns of practice,” she said. “The failure to do so compromises women’s autonomy in making evidence-informed decisions regarding childbirth interventions, such as evaluating the short- and long-term risks of OVD and cesarean delivery.

Her group recommended that morbidity following OVD be weighed against potential alternatives to such procedures, which carry their own risks. “This includes an extended second stage of labor and a spontaneous vaginal delivery, or a second-stage cesarean delivery, both of which are associated with significant morbidity,” Dr. Muraca said. “However, a comprehensive consideration of high population rates of OVD morbidity also prompts questions about choice of instrument, obstetrician training in OVD use, and for recognizing cases that would benefit from a cesarean delivery earlier in labor.”

Alan Peaceman, MD, professor of obstetrics and gynecology at Northwestern University, Chicago, said he was not surprised by the rates of sphincter injury, but that the rate of severe neonatal injury rate was higher than he expected. However, he added, “I don’t think clinicians should change their approach based on a single study. They should continue with the approach that they are most skilled at and is appropriate for the clinical circumstances.”

The study was funded by a grant from the Canadian Institutes of Health Research. Dr. Muraca and Dr. Peaceman have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

A new investigation has found that rates of physical trauma following operative vaginal delivery (OVD) in Canada are higher than previously reported.

The cohort study of more than 1.3 million deliveries in the country found trauma rates were highest with forceps delivery, with more than 1 in 4 pregnancies resulting in maternal trauma and 1 in 105 infants experiencing neonatal trauma. Maternal and neonatal trauma following vacuum deliveries was less common, occurring in 1 in 8 pregnancies and 1 in 104 infants, according to the researchers, who reported their findings in the Canadian Medical Association Journal .

“The rates of trauma following OVD in Canada are higher than previously reported, irrespective of region, level of obstetric care, and volume of instrument use among hospitals,” lead author Giulia Muraca, PhD, MPH, assistant professor of obstetrics and gynecology at McMaster University, Hamilton, Ont., said in an interview. “While OVDs may be associated with low rates of morbidity in carefully selected circumstances, the uniformly high rates of trauma among forceps and vacuum deliveries documented across regions, levels of obstetric care, and hospitals show that such conditions do not apply to routine obstetric practice in Canada.”

The American College of Obstetricians and Gynecologists considers OVD a way to reduce the rate of cesarean deliveries. However, the group has also pointed to a decline in familiarity with the procedures among clinicians new to the field.

Current reports also show that while OVD accounts for up to 15% of deliveries in Canada, Australia, and the United Kingdom, the risks associated with the approach are heavily dependent on the expertise of the provider. Declining use of OVD in favor of cesarean delivery has reduced opportunities for clinicians to acquire proficiency in performing these deliveries, according to the researchers.

Given these various factors, the investigators said the consensus on the safety of OVD is under scrutiny.

“An examination of maternal and neonatal trauma among OVD in contemporary practice is necessary to ensure that health care providers, policy makers, and pregnant individuals are informed regarding the risks of OVD typically experienced in routine obstetric practice, rather than those encountered under ideal conditions,” Dr. Muraca said.
 

Over 1 million deliveries studied

Dr. Muraca and colleagues looked at 1,326,191 deliveries occurring across Canada (except Quebec) between April 2013 and March 2019. The researchers included all singleton, term (≥37 weeks), in-hospital deliveries to women who had not undergone a previous cesarean delivery.

The study’s primary outcome measures were composite maternal trauma and composite neonatal trauma. Maternal trauma included obstetric anal sphincter injury (OASI); cervical or high vaginal laceration; pelvic hematoma; obstetric injury to the pelvic organs, pelvic joints, or ligaments; injury to the bladder or urethra; and other pelvic trauma. Neonatal trauma comprised intracranial hemorrhage and laceration, skull fracture, severe injury to the central or peripheral nervous system, fracture of the long bones, injury to the liver or spleen, seizures, and neonatal death.

The analysis found that 38,500 (2.9%) of the cases involved attempted forceps deliveries while 110,987 (8.4%) were attempted vacuum deliveries. Of the attempted forceps deliveries, 1,606 (4.2%) failed, while 8,791 (7.9%) of attempted vacuum deliveries failed.

Maternal trauma was observed in 25.3% of all forceps deliveries (n = 9,728) and 13.2% of all vacuum deliveries (n = 14,614), the researchers reported. The most common form of maternal trauma was OASI, which was observed in 21.52% of women undergoing forceps delivery and 11.67% of those undergoing vacuum delivery. The rates of all other forms of maternal trauma were higher among patients undergoing attempted forceps delivery than among their counterparts undergoing attempted vacuum delivery.

After adjusting for possible confounders, rates of maternal trauma remained higher with forceps than with vacuum deliveries (adjusted rate ratio, 1.70).

The rate of neonatal trauma was comparable for forceps (9.56/1,000 live births) and vacuum deliveries (9.58/1,000 live births). In these cases, damage to the peripheral nervous system was the most common form of neonatal trauma, occurring in 4.85/1,000 live births with forceps delivery and 3.41/1,000 live births for vacuum delivery, the researchers found.
 

Consider morbidity following OVD against potential alternatives, authors say

According to Dr. Muraca, the rates of maternal trauma in her study – along with accumulating evidence of the severe long-term consequences of these injuries – demonstrates the importance of reporting timely, empirically derived risk measures that accurately reflect those that pregnant individuals may encounter in typical obstetric practice.

“Although there is merit in understanding the estimates of risk that can be achieved when conditions are optimal, the interpretation of these estimates can be misleading, especially given secular shifts in patterns of practice,” she said. “The failure to do so compromises women’s autonomy in making evidence-informed decisions regarding childbirth interventions, such as evaluating the short- and long-term risks of OVD and cesarean delivery.

Her group recommended that morbidity following OVD be weighed against potential alternatives to such procedures, which carry their own risks. “This includes an extended second stage of labor and a spontaneous vaginal delivery, or a second-stage cesarean delivery, both of which are associated with significant morbidity,” Dr. Muraca said. “However, a comprehensive consideration of high population rates of OVD morbidity also prompts questions about choice of instrument, obstetrician training in OVD use, and for recognizing cases that would benefit from a cesarean delivery earlier in labor.”

Alan Peaceman, MD, professor of obstetrics and gynecology at Northwestern University, Chicago, said he was not surprised by the rates of sphincter injury, but that the rate of severe neonatal injury rate was higher than he expected. However, he added, “I don’t think clinicians should change their approach based on a single study. They should continue with the approach that they are most skilled at and is appropriate for the clinical circumstances.”

The study was funded by a grant from the Canadian Institutes of Health Research. Dr. Muraca and Dr. Peaceman have disclosed no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Key clinical point: Between 2005 and 2019, sorafenib therapy has led to improvement in clinical outcomes among treatment-naïve patients with advanced hepatocellular carcinoma (HCC) in concurrence with a decrease in the median duration of therapy.

Main finding: While the median duration of therapy decreased by 53%, from 23.1 weeks to 12.2 weeks (P = .003) over the study period, the median overall survival increased by 4.5 months (P = .048) and the objective response rate increased by 6 months (P = .003).

Study details: This was an analysis of 16 randomized clinical trials (9 phase 3 and 7 phase 2) conducted from 2005-2019, wherein sorafenib was administered to 4,086 patients with advanced HCC naïve to systemic therapy to compare its effect relative to another systemic therapy or placebo.

Disclosures: The study received grants from the National Institutes of Health. M Yarchoan declared receiving research grants from or working as a consultant for various organizations.

Source: Brown TJ et al. Gastrointest Tumors. 2021 Dec 22. doi: 10.1159/000521625.

Key clinical point: Between 2005 and 2019, sorafenib therapy has led to improvement in clinical outcomes among treatment-naïve patients with advanced hepatocellular carcinoma (HCC) in concurrence with a decrease in the median duration of therapy.

Main finding: While the median duration of therapy decreased by 53%, from 23.1 weeks to 12.2 weeks (P = .003) over the study period, the median overall survival increased by 4.5 months (P = .048) and the objective response rate increased by 6 months (P = .003).

Study details: This was an analysis of 16 randomized clinical trials (9 phase 3 and 7 phase 2) conducted from 2005-2019, wherein sorafenib was administered to 4,086 patients with advanced HCC naïve to systemic therapy to compare its effect relative to another systemic therapy or placebo.

Disclosures: The study received grants from the National Institutes of Health. M Yarchoan declared receiving research grants from or working as a consultant for various organizations.

Source: Brown TJ et al. Gastrointest Tumors. 2021 Dec 22. doi: 10.1159/000521625.

Key clinical point: Between 2005 and 2019, sorafenib therapy has led to improvement in clinical outcomes among treatment-naïve patients with advanced hepatocellular carcinoma (HCC) in concurrence with a decrease in the median duration of therapy.

Main finding: While the median duration of therapy decreased by 53%, from 23.1 weeks to 12.2 weeks (P = .003) over the study period, the median overall survival increased by 4.5 months (P = .048) and the objective response rate increased by 6 months (P = .003).

Study details: This was an analysis of 16 randomized clinical trials (9 phase 3 and 7 phase 2) conducted from 2005-2019, wherein sorafenib was administered to 4,086 patients with advanced HCC naïve to systemic therapy to compare its effect relative to another systemic therapy or placebo.

Disclosures: The study received grants from the National Institutes of Health. M Yarchoan declared receiving research grants from or working as a consultant for various organizations.

Source: Brown TJ et al. Gastrointest Tumors. 2021 Dec 22. doi: 10.1159/000521625.

Key clinical point: Having undergone drug-eluting bead transarterial chemoembolization (DEB-TACE), treatment response and disease-free survival (DFS) in patients with hepatocellular carcinoma (HCC) could be predicted by MRI signal intensity in the hepatobiliary phase (HBP) and serum alpha-fetoprotein (AFP) levels, respectively.

Main finding: The only significant predictive factors of noncomplete response and short DFS were signal intensity heterogeneity in the HBP (adjusted odds ratio, 4.807; P = .048) and elevated serum AFP levels (≥30 ng/mL; adjusted hazard ratio, 2.916; P = .040), respectively.

Study details: This was a preliminary single-center retrospective study including 55 treatment-naive patients who underwent DEB-TACE for HCC.

Disclosures: The study was sponsored by the Bio & Medical Technology Development Program of the National Research Foundation funded by the Korean government. The authors reported no conflict of interests.

Source: Lee JY et al. Sci Rep. 2021 Dec 15. doi: 10.1038/s41598-021-01839-6.

Key clinical point: Having undergone drug-eluting bead transarterial chemoembolization (DEB-TACE), treatment response and disease-free survival (DFS) in patients with hepatocellular carcinoma (HCC) could be predicted by MRI signal intensity in the hepatobiliary phase (HBP) and serum alpha-fetoprotein (AFP) levels, respectively.

Main finding: The only significant predictive factors of noncomplete response and short DFS were signal intensity heterogeneity in the HBP (adjusted odds ratio, 4.807; P = .048) and elevated serum AFP levels (≥30 ng/mL; adjusted hazard ratio, 2.916; P = .040), respectively.

Study details: This was a preliminary single-center retrospective study including 55 treatment-naive patients who underwent DEB-TACE for HCC.

Disclosures: The study was sponsored by the Bio & Medical Technology Development Program of the National Research Foundation funded by the Korean government. The authors reported no conflict of interests.

Source: Lee JY et al. Sci Rep. 2021 Dec 15. doi: 10.1038/s41598-021-01839-6.

Key clinical point: Having undergone drug-eluting bead transarterial chemoembolization (DEB-TACE), treatment response and disease-free survival (DFS) in patients with hepatocellular carcinoma (HCC) could be predicted by MRI signal intensity in the hepatobiliary phase (HBP) and serum alpha-fetoprotein (AFP) levels, respectively.

Main finding: The only significant predictive factors of noncomplete response and short DFS were signal intensity heterogeneity in the HBP (adjusted odds ratio, 4.807; P = .048) and elevated serum AFP levels (≥30 ng/mL; adjusted hazard ratio, 2.916; P = .040), respectively.

Study details: This was a preliminary single-center retrospective study including 55 treatment-naive patients who underwent DEB-TACE for HCC.

Disclosures: The study was sponsored by the Bio & Medical Technology Development Program of the National Research Foundation funded by the Korean government. The authors reported no conflict of interests.

Source: Lee JY et al. Sci Rep. 2021 Dec 15. doi: 10.1038/s41598-021-01839-6.

Key clinical point: Compared with radiofrequency ablation (RFA), microwave ablation (MWA) effectuates better 1- and 2-year disease-free survival (DFS) along with a lower risk of major complications in patients with hepatocellular carcinoma (HCC).

Main finding: Although both ablation therapies led to a similar 2-year overall survival (P = .573), MWA achieved better 1-year DFS (79.7% vs 60.7%; P = .035) and 2-year DFS (72.5% vs 45.4%; P = .02) rates than RFA. Concurrently, MWA showed a lower rate of major complications than RFA (14% vs 29%; P = .043).

Study details: Findings are from a retrospective cohort study involving 150 patients with HCC, including treatment-naïve and recurrent HCC, who were treated with either RFA (n=100) or MWA (n=50).

Disclosures: The study was sponsored by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education. No conflict of interests was reported by the authors.

Source: Lee SK et al. J Clin Med. 2022 Jan 7. doi: 10.3390/jcm11020302.

Key clinical point: Compared with radiofrequency ablation (RFA), microwave ablation (MWA) effectuates better 1- and 2-year disease-free survival (DFS) along with a lower risk of major complications in patients with hepatocellular carcinoma (HCC).

Main finding: Although both ablation therapies led to a similar 2-year overall survival (P = .573), MWA achieved better 1-year DFS (79.7% vs 60.7%; P = .035) and 2-year DFS (72.5% vs 45.4%; P = .02) rates than RFA. Concurrently, MWA showed a lower rate of major complications than RFA (14% vs 29%; P = .043).

Study details: Findings are from a retrospective cohort study involving 150 patients with HCC, including treatment-naïve and recurrent HCC, who were treated with either RFA (n=100) or MWA (n=50).

Disclosures: The study was sponsored by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education. No conflict of interests was reported by the authors.

Source: Lee SK et al. J Clin Med. 2022 Jan 7. doi: 10.3390/jcm11020302.

Key clinical point: Compared with radiofrequency ablation (RFA), microwave ablation (MWA) effectuates better 1- and 2-year disease-free survival (DFS) along with a lower risk of major complications in patients with hepatocellular carcinoma (HCC).

Main finding: Although both ablation therapies led to a similar 2-year overall survival (P = .573), MWA achieved better 1-year DFS (79.7% vs 60.7%; P = .035) and 2-year DFS (72.5% vs 45.4%; P = .02) rates than RFA. Concurrently, MWA showed a lower rate of major complications than RFA (14% vs 29%; P = .043).

Study details: Findings are from a retrospective cohort study involving 150 patients with HCC, including treatment-naïve and recurrent HCC, who were treated with either RFA (n=100) or MWA (n=50).

Disclosures: The study was sponsored by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education. No conflict of interests was reported by the authors.

Source: Lee SK et al. J Clin Med. 2022 Jan 7. doi: 10.3390/jcm11020302.

Key clinical point: First-line radiofrequency ablation (RFA) is associated with worse long-term therapeutic outcomes for single periportal hepatocellular carcinoma (HCC) than for single nonperiportal HCC.

Main finding: At 1 and 5 years, periportal vs nonperiportal HCC was associated with significantly higher local tumor progression rates (15.7% and 46.9% vs 6.0% and 28.7%, respectively; P = .007) and worse overall survival rates (81.3% and 42.9% vs 99.3% and 78.1%, respectively; P < .0001).

Study details: The data come from a retrospective study involving 233 patients with HCC, either periportal (n=56) or nonperiportal (n=177), who underwent percutaneous RFA alone or combined with transarterial chemoembolization as first-line treatment.

Disclosures: The authors reported no funding source or conflict of interests.

Source: Cao S et al. Cancer Imaging. 2022 Jan 4. doi: 10.1186/s40644-021-00442-2.

Key clinical point: First-line radiofrequency ablation (RFA) is associated with worse long-term therapeutic outcomes for single periportal hepatocellular carcinoma (HCC) than for single nonperiportal HCC.

Main finding: At 1 and 5 years, periportal vs nonperiportal HCC was associated with significantly higher local tumor progression rates (15.7% and 46.9% vs 6.0% and 28.7%, respectively; P = .007) and worse overall survival rates (81.3% and 42.9% vs 99.3% and 78.1%, respectively; P < .0001).

Study details: The data come from a retrospective study involving 233 patients with HCC, either periportal (n=56) or nonperiportal (n=177), who underwent percutaneous RFA alone or combined with transarterial chemoembolization as first-line treatment.

Disclosures: The authors reported no funding source or conflict of interests.

Source: Cao S et al. Cancer Imaging. 2022 Jan 4. doi: 10.1186/s40644-021-00442-2.

Key clinical point: First-line radiofrequency ablation (RFA) is associated with worse long-term therapeutic outcomes for single periportal hepatocellular carcinoma (HCC) than for single nonperiportal HCC.

Main finding: At 1 and 5 years, periportal vs nonperiportal HCC was associated with significantly higher local tumor progression rates (15.7% and 46.9% vs 6.0% and 28.7%, respectively; P = .007) and worse overall survival rates (81.3% and 42.9% vs 99.3% and 78.1%, respectively; P < .0001).

Study details: The data come from a retrospective study involving 233 patients with HCC, either periportal (n=56) or nonperiportal (n=177), who underwent percutaneous RFA alone or combined with transarterial chemoembolization as first-line treatment.

Disclosures: The authors reported no funding source or conflict of interests.

Source: Cao S et al. Cancer Imaging. 2022 Jan 4. doi: 10.1186/s40644-021-00442-2.

Key clinical point: As initial treatment, hepatic arterial infusion chemotherapy (HAIC) effectuates a greater survival and radiological response than transarterial chemoembolization (TACE) among patients with infiltrative hepatocellular carcinoma (HCC).

Main finding: HIAC vs TACE led to a longer median overall survival (13.3 months vs 10.8 months; P = .043) and progression-free survival (7.8 months vs 4.0 months; P = .035) along with higher objective response (34.8% vs 11.8%; P = .001) and disease control (54.3% vs 36.8%; P = .028) rates.

Study details: Findings are from a retrospective real-world study including 160 adult patients with large infiltrative HCCs who underwent either HAIC (n=92) or TACE (n=68) as initial treatment.

Disclosures: The authors declared receiving no financial assistance for the study and having no potential conflict of interests.

Source: An C et al. Front Oncol. 2021 Dec 16. doi: 10.3389/fonc.2021.747496.

Key clinical point: As initial treatment, hepatic arterial infusion chemotherapy (HAIC) effectuates a greater survival and radiological response than transarterial chemoembolization (TACE) among patients with infiltrative hepatocellular carcinoma (HCC).

Main finding: HIAC vs TACE led to a longer median overall survival (13.3 months vs 10.8 months; P = .043) and progression-free survival (7.8 months vs 4.0 months; P = .035) along with higher objective response (34.8% vs 11.8%; P = .001) and disease control (54.3% vs 36.8%; P = .028) rates.

Study details: Findings are from a retrospective real-world study including 160 adult patients with large infiltrative HCCs who underwent either HAIC (n=92) or TACE (n=68) as initial treatment.

Disclosures: The authors declared receiving no financial assistance for the study and having no potential conflict of interests.

Source: An C et al. Front Oncol. 2021 Dec 16. doi: 10.3389/fonc.2021.747496.

Key clinical point: As initial treatment, hepatic arterial infusion chemotherapy (HAIC) effectuates a greater survival and radiological response than transarterial chemoembolization (TACE) among patients with infiltrative hepatocellular carcinoma (HCC).

Main finding: HIAC vs TACE led to a longer median overall survival (13.3 months vs 10.8 months; P = .043) and progression-free survival (7.8 months vs 4.0 months; P = .035) along with higher objective response (34.8% vs 11.8%; P = .001) and disease control (54.3% vs 36.8%; P = .028) rates.

Study details: Findings are from a retrospective real-world study including 160 adult patients with large infiltrative HCCs who underwent either HAIC (n=92) or TACE (n=68) as initial treatment.

Disclosures: The authors declared receiving no financial assistance for the study and having no potential conflict of interests.

Source: An C et al. Front Oncol. 2021 Dec 16. doi: 10.3389/fonc.2021.747496.

Key clinical point: Modified Response Evaluation Criteria in Solid Tumors (mRECIST)-determined objective response (OR) and early tumor shrinkage (ETS) may serve as independent prognostic factors for overall survival (OS) in patients with advanced hepatocellular carcinoma (HCC) on sorafenib monotherapy.

Main finding: OR assessed by mRECIST (adjusted hazard ratio [aHR], 0.32; P < .001) and ETS (aHR, 0.44; P < .001) were independent prognostic factors for OS. A longer median OS was shown by responders vs nonresponders (30.3 months vs 11.4 months; P < .001) and by patients with ETS ≥20% vs those with ETS <20% (22.1 months vs 11.4 months; P < .001).

Study details: This was a post hoc analysis of data from the phase 2 SORAMIC trial and included 115 patients with advanced HCC receiving sorafenib monotherapy.

Disclosures: The study was sponsored by Sirtex Medical and Bayer Healthcare. Some of the authors declared receiving personal fees and research grants from various sources including Bayer and Sirtex.

Source: Öcal O et al. Cancer Imaging. 2022 Jan 4. doi: 10.1186/s40644-021-00439-x.

Key clinical point: Modified Response Evaluation Criteria in Solid Tumors (mRECIST)-determined objective response (OR) and early tumor shrinkage (ETS) may serve as independent prognostic factors for overall survival (OS) in patients with advanced hepatocellular carcinoma (HCC) on sorafenib monotherapy.

Main finding: OR assessed by mRECIST (adjusted hazard ratio [aHR], 0.32; P < .001) and ETS (aHR, 0.44; P < .001) were independent prognostic factors for OS. A longer median OS was shown by responders vs nonresponders (30.3 months vs 11.4 months; P < .001) and by patients with ETS ≥20% vs those with ETS <20% (22.1 months vs 11.4 months; P < .001).

Study details: This was a post hoc analysis of data from the phase 2 SORAMIC trial and included 115 patients with advanced HCC receiving sorafenib monotherapy.

Disclosures: The study was sponsored by Sirtex Medical and Bayer Healthcare. Some of the authors declared receiving personal fees and research grants from various sources including Bayer and Sirtex.

Source: Öcal O et al. Cancer Imaging. 2022 Jan 4. doi: 10.1186/s40644-021-00439-x.

Key clinical point: Modified Response Evaluation Criteria in Solid Tumors (mRECIST)-determined objective response (OR) and early tumor shrinkage (ETS) may serve as independent prognostic factors for overall survival (OS) in patients with advanced hepatocellular carcinoma (HCC) on sorafenib monotherapy.

Main finding: OR assessed by mRECIST (adjusted hazard ratio [aHR], 0.32; P < .001) and ETS (aHR, 0.44; P < .001) were independent prognostic factors for OS. A longer median OS was shown by responders vs nonresponders (30.3 months vs 11.4 months; P < .001) and by patients with ETS ≥20% vs those with ETS <20% (22.1 months vs 11.4 months; P < .001).

Study details: This was a post hoc analysis of data from the phase 2 SORAMIC trial and included 115 patients with advanced HCC receiving sorafenib monotherapy.

Disclosures: The study was sponsored by Sirtex Medical and Bayer Healthcare. Some of the authors declared receiving personal fees and research grants from various sources including Bayer and Sirtex.

Source: Öcal O et al. Cancer Imaging. 2022 Jan 4. doi: 10.1186/s40644-021-00439-x.

Key clinical point: Lowering the current United Network for Organ Sharing-recommended alpha-fetoprotein (AFP) level threshold for exclusion from liver transplant (LT) to ≥500 ng/mL for all patients with hepatocellular carcinoma (HCC) instead of only for those with AFP levels >1000 ng/mL could improve post-LT outcomes.

Main finding: After multivariable adjustment, an AFP level ≥500 ng/mL at LT was associated with an elevated risk of post-LT mortality (adjusted hazard ratio [aHR], 1.5; P = .02) and HCC recurrence (aHR, 1.88; P = .02) compared with an AFP level <100 ng/mL.

Study details: This was a retrospective cohort study involving 1,766 adult patients with HCC who had undergone LT and had listing AFP levels between 100 ng/mL and 999 ng/mL at initial model for end-stage liver disease exception.

Disclosures: The study was funded by the UCSF Clinical and Translational Science Institute Research Funding Award and UCSF Liver Center. Some of the authors reported being on the advisory board of or receiving research grants from various organizations.

Source: Goldman ML et al. Liver Transpl. 2021 Dec 20. doi: 10.1002/lt.26392.

Key clinical point: Lowering the current United Network for Organ Sharing-recommended alpha-fetoprotein (AFP) level threshold for exclusion from liver transplant (LT) to ≥500 ng/mL for all patients with hepatocellular carcinoma (HCC) instead of only for those with AFP levels >1000 ng/mL could improve post-LT outcomes.

Main finding: After multivariable adjustment, an AFP level ≥500 ng/mL at LT was associated with an elevated risk of post-LT mortality (adjusted hazard ratio [aHR], 1.5; P = .02) and HCC recurrence (aHR, 1.88; P = .02) compared with an AFP level <100 ng/mL.

Study details: This was a retrospective cohort study involving 1,766 adult patients with HCC who had undergone LT and had listing AFP levels between 100 ng/mL and 999 ng/mL at initial model for end-stage liver disease exception.

Disclosures: The study was funded by the UCSF Clinical and Translational Science Institute Research Funding Award and UCSF Liver Center. Some of the authors reported being on the advisory board of or receiving research grants from various organizations.

Source: Goldman ML et al. Liver Transpl. 2021 Dec 20. doi: 10.1002/lt.26392.

Key clinical point: Lowering the current United Network for Organ Sharing-recommended alpha-fetoprotein (AFP) level threshold for exclusion from liver transplant (LT) to ≥500 ng/mL for all patients with hepatocellular carcinoma (HCC) instead of only for those with AFP levels >1000 ng/mL could improve post-LT outcomes.

Main finding: After multivariable adjustment, an AFP level ≥500 ng/mL at LT was associated with an elevated risk of post-LT mortality (adjusted hazard ratio [aHR], 1.5; P = .02) and HCC recurrence (aHR, 1.88; P = .02) compared with an AFP level <100 ng/mL.

Study details: This was a retrospective cohort study involving 1,766 adult patients with HCC who had undergone LT and had listing AFP levels between 100 ng/mL and 999 ng/mL at initial model for end-stage liver disease exception.

Disclosures: The study was funded by the UCSF Clinical and Translational Science Institute Research Funding Award and UCSF Liver Center. Some of the authors reported being on the advisory board of or receiving research grants from various organizations.

Source: Goldman ML et al. Liver Transpl. 2021 Dec 20. doi: 10.1002/lt.26392.

Approximately 3% of youth who tested positive for COVID-19 in an emergency department setting had severe outcomes after 2 weeks, but this risk was 0.5% among those not admitted to the hospital, based on data from more than 3,000 individuals aged 18 and younger.

In the early stages of the COVID-19 pandemic, youth younger than 18 years accounted for fewer than 5% of reported cases, but now account for approximately 25% of positive cases, wrote Anna L. Funk, PhD, of the University of Calgary, Alberta, Canada, and colleagues.

However, the risk of severe outcomes of youth with COVID-19 remains poorly understood and data from large studies are lacking, they noted.

In a prospective cohort study published in JAMA Network Open, the researchers reviewed data from 3,221 children and adolescents who were tested for COVID-19 at one of 41 emergency departments in 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States between March 2020 and June 2021. Positive infections were confirmed by polymerase chain reaction (PCR) testing. At 14 days’ follow-up after a positive test, 735 patients (22.8%), were hospitalized, 107 (3.3%) had severe outcomes, and 4 (0.12%) had died. Severe outcomes were significantly more likely in children aged 5-10 years and 10-18 years vs. less than 1 year (odds ratios, 1.60 and 2.39, respectively), and in children with a self-reported chronic illness (OR, 2.34) or a prior episode of pneumonia (OR, 3.15).

Severe outcomes were more likely in patients who presented with symptoms that started 4-7 days before seeking care, compared with those whose symptoms started 0-3 days before seeking care (OR, 2.22).

The researchers also reviewed data from a subgroup of 2,510 individuals who were discharged home from the ED after initial testing. At 14 days’ follow-up, 50 of these patients (2.0%) were hospitalized and 12 (0.5%) had severe outcomes. In addition, the researchers found that the risk of severe outcomes among hospitalized COVID-19–positive youth was nearly four times higher, compared with hospitalized youth who tested negative for COVID-19 (risk difference, 3.9%).

Previous retrospective studies of severe outcomes in children and adolescents with COVID-19 have yielded varying results, in part because of the variation in study populations, the researchers noted in their discussion of the findings. “Our study population provides a risk estimate for youths brought for ED care.” Therefore, “Our lower estimate of severe disease likely reflects our stringent definition, which required the occurrence of complications or specific invasive interventions,” they said.

The study limitations included the potential overestimation of the risk of severe outcomes because patients were recruited in the ED, the researchers noted. Other limitations included variation in regional case definitions, screening criteria, and testing capacity among different sites and time periods. “Thus, 5% of our SARS-CoV-2–positive participants were asymptomatic – most of whom were tested as they were positive contacts of known cases or as part of routine screening procedures,” they said. The findings also are not generalizable to all community EDs and did not account for variants, they added.

However, the results were strengthened by the ability to compare outcomes for children with positive tests to similar children with negative tests, and add to the literature showing an increased risk of severe outcomes for those hospitalized with positive tests, the researchers concluded.
 

Data may inform clinical decisions

“The data [in the current study] are concerning for severe outcomes for children even prior to the Omicron strain,” said Margaret Thew, DNP, FP-BC, of Children’s Wisconsin-Milwaukee Hospital, in an interview. “Presently, the number of children infected with the Omicron strain is much higher and hospitalizations among children are at their highest since COVID-19 began,” she said. “For medical providers caring for this population, the study sheds light on pediatric patients who may be at higher risk of severe illness when they become infected with COVID-19,” she added.

“I was surprised by how high the number of pediatric patients hospitalized (22%) and the percentage (3%) with severe disease were during this time,” given that the timeline for these data preceded the spread of the Omicron strain, said Ms. Thew. “The risk of prior pneumonia was quite surprising. I do not recall seeing prior pneumonia as a risk factor for more severe COVID-19 with children or adults,” she added.

The take-home messaging for clinicians caring for children and adolescents is the added knowledge of the risk factors for severe outcomes from COVID-19, including the 10-18 age range, chronic illness, prior pneumonia, and longer symptom duration before seeking care in the ED, Ms. Thew emphasized.

However, additional research is needed on the impact of the new strains of COVID-19 on pediatric and adolescent hospitalizations, Ms. Thew said. Research also is needed on the other illnesses that have resulted from COVID-19, including illness requiring antibiotic use or medical interventions or treatments, and on the risk of combined COVID-19 and influenza viruses, she noted.

The study was supported by the Canadian Institutes of Health Research, Alberta Innovates, the Alberta Health Services University of Calgary Clinical Research Fund, the Alberta Children’s Hospital Research Institute, the COVID-19 Research Accelerator Funding Track (CRAFT) Program at the University of California, Davis, and the Cincinnati Children’s Hospital Medical Center Division of Emergency Medicine Small Grants Program. Lead author Dr. Funk was supported by the University of Calgary Eyes-High Post-Doctoral Research Fund, but had no financial conflicts to disclose. Ms. Thew had no financial conflicts to disclose and serves on the Editorial Advisory Board of Pediatric News.

Approximately 3% of youth who tested positive for COVID-19 in an emergency department setting had severe outcomes after 2 weeks, but this risk was 0.5% among those not admitted to the hospital, based on data from more than 3,000 individuals aged 18 and younger.

In the early stages of the COVID-19 pandemic, youth younger than 18 years accounted for fewer than 5% of reported cases, but now account for approximately 25% of positive cases, wrote Anna L. Funk, PhD, of the University of Calgary, Alberta, Canada, and colleagues.

However, the risk of severe outcomes of youth with COVID-19 remains poorly understood and data from large studies are lacking, they noted.

In a prospective cohort study published in JAMA Network Open, the researchers reviewed data from 3,221 children and adolescents who were tested for COVID-19 at one of 41 emergency departments in 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States between March 2020 and June 2021. Positive infections were confirmed by polymerase chain reaction (PCR) testing. At 14 days’ follow-up after a positive test, 735 patients (22.8%), were hospitalized, 107 (3.3%) had severe outcomes, and 4 (0.12%) had died. Severe outcomes were significantly more likely in children aged 5-10 years and 10-18 years vs. less than 1 year (odds ratios, 1.60 and 2.39, respectively), and in children with a self-reported chronic illness (OR, 2.34) or a prior episode of pneumonia (OR, 3.15).

Severe outcomes were more likely in patients who presented with symptoms that started 4-7 days before seeking care, compared with those whose symptoms started 0-3 days before seeking care (OR, 2.22).

The researchers also reviewed data from a subgroup of 2,510 individuals who were discharged home from the ED after initial testing. At 14 days’ follow-up, 50 of these patients (2.0%) were hospitalized and 12 (0.5%) had severe outcomes. In addition, the researchers found that the risk of severe outcomes among hospitalized COVID-19–positive youth was nearly four times higher, compared with hospitalized youth who tested negative for COVID-19 (risk difference, 3.9%).

Previous retrospective studies of severe outcomes in children and adolescents with COVID-19 have yielded varying results, in part because of the variation in study populations, the researchers noted in their discussion of the findings. “Our study population provides a risk estimate for youths brought for ED care.” Therefore, “Our lower estimate of severe disease likely reflects our stringent definition, which required the occurrence of complications or specific invasive interventions,” they said.

The study limitations included the potential overestimation of the risk of severe outcomes because patients were recruited in the ED, the researchers noted. Other limitations included variation in regional case definitions, screening criteria, and testing capacity among different sites and time periods. “Thus, 5% of our SARS-CoV-2–positive participants were asymptomatic – most of whom were tested as they were positive contacts of known cases or as part of routine screening procedures,” they said. The findings also are not generalizable to all community EDs and did not account for variants, they added.

However, the results were strengthened by the ability to compare outcomes for children with positive tests to similar children with negative tests, and add to the literature showing an increased risk of severe outcomes for those hospitalized with positive tests, the researchers concluded.
 

Data may inform clinical decisions

“The data [in the current study] are concerning for severe outcomes for children even prior to the Omicron strain,” said Margaret Thew, DNP, FP-BC, of Children’s Wisconsin-Milwaukee Hospital, in an interview. “Presently, the number of children infected with the Omicron strain is much higher and hospitalizations among children are at their highest since COVID-19 began,” she said. “For medical providers caring for this population, the study sheds light on pediatric patients who may be at higher risk of severe illness when they become infected with COVID-19,” she added.

“I was surprised by how high the number of pediatric patients hospitalized (22%) and the percentage (3%) with severe disease were during this time,” given that the timeline for these data preceded the spread of the Omicron strain, said Ms. Thew. “The risk of prior pneumonia was quite surprising. I do not recall seeing prior pneumonia as a risk factor for more severe COVID-19 with children or adults,” she added.

The take-home messaging for clinicians caring for children and adolescents is the added knowledge of the risk factors for severe outcomes from COVID-19, including the 10-18 age range, chronic illness, prior pneumonia, and longer symptom duration before seeking care in the ED, Ms. Thew emphasized.

However, additional research is needed on the impact of the new strains of COVID-19 on pediatric and adolescent hospitalizations, Ms. Thew said. Research also is needed on the other illnesses that have resulted from COVID-19, including illness requiring antibiotic use or medical interventions or treatments, and on the risk of combined COVID-19 and influenza viruses, she noted.

The study was supported by the Canadian Institutes of Health Research, Alberta Innovates, the Alberta Health Services University of Calgary Clinical Research Fund, the Alberta Children’s Hospital Research Institute, the COVID-19 Research Accelerator Funding Track (CRAFT) Program at the University of California, Davis, and the Cincinnati Children’s Hospital Medical Center Division of Emergency Medicine Small Grants Program. Lead author Dr. Funk was supported by the University of Calgary Eyes-High Post-Doctoral Research Fund, but had no financial conflicts to disclose. Ms. Thew had no financial conflicts to disclose and serves on the Editorial Advisory Board of Pediatric News.

Approximately 3% of youth who tested positive for COVID-19 in an emergency department setting had severe outcomes after 2 weeks, but this risk was 0.5% among those not admitted to the hospital, based on data from more than 3,000 individuals aged 18 and younger.

In the early stages of the COVID-19 pandemic, youth younger than 18 years accounted for fewer than 5% of reported cases, but now account for approximately 25% of positive cases, wrote Anna L. Funk, PhD, of the University of Calgary, Alberta, Canada, and colleagues.

However, the risk of severe outcomes of youth with COVID-19 remains poorly understood and data from large studies are lacking, they noted.

In a prospective cohort study published in JAMA Network Open, the researchers reviewed data from 3,221 children and adolescents who were tested for COVID-19 at one of 41 emergency departments in 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States between March 2020 and June 2021. Positive infections were confirmed by polymerase chain reaction (PCR) testing. At 14 days’ follow-up after a positive test, 735 patients (22.8%), were hospitalized, 107 (3.3%) had severe outcomes, and 4 (0.12%) had died. Severe outcomes were significantly more likely in children aged 5-10 years and 10-18 years vs. less than 1 year (odds ratios, 1.60 and 2.39, respectively), and in children with a self-reported chronic illness (OR, 2.34) or a prior episode of pneumonia (OR, 3.15).

Severe outcomes were more likely in patients who presented with symptoms that started 4-7 days before seeking care, compared with those whose symptoms started 0-3 days before seeking care (OR, 2.22).

The researchers also reviewed data from a subgroup of 2,510 individuals who were discharged home from the ED after initial testing. At 14 days’ follow-up, 50 of these patients (2.0%) were hospitalized and 12 (0.5%) had severe outcomes. In addition, the researchers found that the risk of severe outcomes among hospitalized COVID-19–positive youth was nearly four times higher, compared with hospitalized youth who tested negative for COVID-19 (risk difference, 3.9%).

Previous retrospective studies of severe outcomes in children and adolescents with COVID-19 have yielded varying results, in part because of the variation in study populations, the researchers noted in their discussion of the findings. “Our study population provides a risk estimate for youths brought for ED care.” Therefore, “Our lower estimate of severe disease likely reflects our stringent definition, which required the occurrence of complications or specific invasive interventions,” they said.

The study limitations included the potential overestimation of the risk of severe outcomes because patients were recruited in the ED, the researchers noted. Other limitations included variation in regional case definitions, screening criteria, and testing capacity among different sites and time periods. “Thus, 5% of our SARS-CoV-2–positive participants were asymptomatic – most of whom were tested as they were positive contacts of known cases or as part of routine screening procedures,” they said. The findings also are not generalizable to all community EDs and did not account for variants, they added.

However, the results were strengthened by the ability to compare outcomes for children with positive tests to similar children with negative tests, and add to the literature showing an increased risk of severe outcomes for those hospitalized with positive tests, the researchers concluded.
 

Data may inform clinical decisions

“The data [in the current study] are concerning for severe outcomes for children even prior to the Omicron strain,” said Margaret Thew, DNP, FP-BC, of Children’s Wisconsin-Milwaukee Hospital, in an interview. “Presently, the number of children infected with the Omicron strain is much higher and hospitalizations among children are at their highest since COVID-19 began,” she said. “For medical providers caring for this population, the study sheds light on pediatric patients who may be at higher risk of severe illness when they become infected with COVID-19,” she added.

“I was surprised by how high the number of pediatric patients hospitalized (22%) and the percentage (3%) with severe disease were during this time,” given that the timeline for these data preceded the spread of the Omicron strain, said Ms. Thew. “The risk of prior pneumonia was quite surprising. I do not recall seeing prior pneumonia as a risk factor for more severe COVID-19 with children or adults,” she added.

The take-home messaging for clinicians caring for children and adolescents is the added knowledge of the risk factors for severe outcomes from COVID-19, including the 10-18 age range, chronic illness, prior pneumonia, and longer symptom duration before seeking care in the ED, Ms. Thew emphasized.

However, additional research is needed on the impact of the new strains of COVID-19 on pediatric and adolescent hospitalizations, Ms. Thew said. Research also is needed on the other illnesses that have resulted from COVID-19, including illness requiring antibiotic use or medical interventions or treatments, and on the risk of combined COVID-19 and influenza viruses, she noted.

The study was supported by the Canadian Institutes of Health Research, Alberta Innovates, the Alberta Health Services University of Calgary Clinical Research Fund, the Alberta Children’s Hospital Research Institute, the COVID-19 Research Accelerator Funding Track (CRAFT) Program at the University of California, Davis, and the Cincinnati Children’s Hospital Medical Center Division of Emergency Medicine Small Grants Program. Lead author Dr. Funk was supported by the University of Calgary Eyes-High Post-Doctoral Research Fund, but had no financial conflicts to disclose. Ms. Thew had no financial conflicts to disclose and serves on the Editorial Advisory Board of Pediatric News.

Key clinical point: Individuals with persistent or incident body fatness show an increased risk of developing hepatocellular carcinoma (HCC).

Main finding: Compared with their persistent no-fatness counterparts, both general fatness (persistent: adjusted hazard ratio [aHR], 1.28; 95% CI, 1.23-1.34; incident: aHR, 1.10; 95% CI, 1.01-1.20) and central fatness (persistent: aHR, 1.33; 95% CI, 1.26-1.40; incident: aHR, 1.19; 95% CI, 1.11-1.27) were associated with an increased risk of HCC.

Study details: The data come from a nationwide population-based cohort study including 6,789,472 individuals aged 20 years or older who were not previously diagnosed with HCC and underwent health examinations twice with a gap of 2 years.

Disclosures: The study was sponsored by the Research Supporting Program of The Korean Association for the Study of the Liver and the Korean Liver Foundation. The authors declared no conflict of interests.

Source: Kim MN et al. Int J Cancer. 2021 Dec 26. doi: 10.1002/ijc.33920.

Key clinical point: Individuals with persistent or incident body fatness show an increased risk of developing hepatocellular carcinoma (HCC).

Main finding: Compared with their persistent no-fatness counterparts, both general fatness (persistent: adjusted hazard ratio [aHR], 1.28; 95% CI, 1.23-1.34; incident: aHR, 1.10; 95% CI, 1.01-1.20) and central fatness (persistent: aHR, 1.33; 95% CI, 1.26-1.40; incident: aHR, 1.19; 95% CI, 1.11-1.27) were associated with an increased risk of HCC.

Study details: The data come from a nationwide population-based cohort study including 6,789,472 individuals aged 20 years or older who were not previously diagnosed with HCC and underwent health examinations twice with a gap of 2 years.

Disclosures: The study was sponsored by the Research Supporting Program of The Korean Association for the Study of the Liver and the Korean Liver Foundation. The authors declared no conflict of interests.

Source: Kim MN et al. Int J Cancer. 2021 Dec 26. doi: 10.1002/ijc.33920.

Key clinical point: Individuals with persistent or incident body fatness show an increased risk of developing hepatocellular carcinoma (HCC).

Main finding: Compared with their persistent no-fatness counterparts, both general fatness (persistent: adjusted hazard ratio [aHR], 1.28; 95% CI, 1.23-1.34; incident: aHR, 1.10; 95% CI, 1.01-1.20) and central fatness (persistent: aHR, 1.33; 95% CI, 1.26-1.40; incident: aHR, 1.19; 95% CI, 1.11-1.27) were associated with an increased risk of HCC.

Study details: The data come from a nationwide population-based cohort study including 6,789,472 individuals aged 20 years or older who were not previously diagnosed with HCC and underwent health examinations twice with a gap of 2 years.

Disclosures: The study was sponsored by the Research Supporting Program of The Korean Association for the Study of the Liver and the Korean Liver Foundation. The authors declared no conflict of interests.

Source: Kim MN et al. Int J Cancer. 2021 Dec 26. doi: 10.1002/ijc.33920.