Predictive risk score of respiratory complications in children with mediastinal tumors: A case–control study

• Published in: Cancer medicine (Malden, MA) Vol. 12; no. 2; pp. 1167 - 1176
• Main Authors: Honda, Mamoru, Yuki, Arakawa, Takahiro, Hosokawa, Chigusa, Oyama, Yuichi, Mitani, Makiko, Mori, Fukuoka, Kohei, Koichi, Oshima, Yutaka, Tanami, Tetsuya, Ishimaru, Hiroshi, Kawashima, Koichi, Mizuta, Ikuya, Ueta, Norifumi, Kuratani, Katsuyoshi, Koh
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.01.2023; John Wiley and Sons Inc; Wiley
• Subjects: Accuracy; Adolescent; Adolescents; Airway management; Anesthesia; Biopsy; Bronchus; Case-Control Studies; Chemotherapy; Chest; Child; Children; Children & youth; Compression; Computed tomography; Cough; Cysts; Diagnosis; Diagnostic tests; Dyspnea; Dyspnea - complications; Effusion; Ewings sarcoma; Humans; Hypoxia; Hypoxia - complications; Intubation; Leukemia; Lymphoma; Mechanical ventilation; Mediastinal Neoplasms - complications; Mediastinal Neoplasms - diagnostic imaging; mediastinal tumor; Medical imaging; Patients; Pleural effusion; Pleural fluid; Respiration; respiratory complications; Respiratory failure; Respiratory Sounds; Retrospective Studies; Risk Factors; risk score; Steroids; Superior Vena Cava Syndrome - complications; Thoracentesis; Tomography; tracheal cross‐sectional area; Tumors; respiratory complications; mediastinal tumor; tracheal cross-sectional area; children; risk score
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.4972

Background The aim of this study was to examine risk factors of respiratory complications at the diagnosis and establish an algorithm of clinical management in children and adolescents with mediastinal tumors. Methods We retrospectively collected clinical information of all children and adolescents who presented with mediastinal tumors at Saitama Children's Medical Center from 1999 to 2019, including age, sex, pathological diagnosis, eight major clinical symptoms (cough, dyspnea, hypoxia, orthopnea, chest pain, wheeze, superior vena cava syndrome, and stridor), chest computed tomography (CT) findings (tumor location, mediastinal mass ratio, pleural fluid, pericardial effusion, and compression of trachea and bronchi), types of diagnostic procedure and anesthesia, respiratory complications (severe hypoxia, difficult ventilation, respiratory failure, and cardiopulmonary arrest), and clinical outcome. Subsequently, we calculated the risk score for predicting respiratory complications by combining clinical and radiological findings. Results Of the 57 patients, 7 (12%) developed respiratory complications. Cough, dyspnea, hypoxia, and orthopnea were significantly more common in patients with complications (p = 0.02, p = 0.02, p < 0.01, p = 0.03, respectively). The reduction of percentage of tracheal cross‐sectional area (%TCA) and compression of the carina in chest CT were also significantly more common in patients with complications (p < 0.01 and <0.01, respectively). We calculated the risk score of respiratory complications by combining cough, wheeze, stridor, orthopnea, dyspnea, hypoxia, %TCA < 0.5, and compression of the carina. A risk score ≥ 7 showed high predictive accuracy for complications (sensitivity: 100%, specificity: 97.7%, positive likelihood ratio: 43.0). Conclusion The risk score combining clinical symptoms with radiological findings is a promising predictive tool for respiratory complications in children with mediastinal tumors. The risk score combining clinical symptoms with radiological findings is a promising predictive tool for respiratory complications in children with mediastinal tumors.