Padmavati Eksambe

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• El-Hallal, M., Shah, Y., Nath, M., Eksambe, P., Theroux, L., Amlicke, M., Steele, F., Krief, W., & Kothare, S. (2021). Length of stay linked to neurodiagnostic workup for seizures presenting to the pediatric emergency department. Epilepsy and Behavior, 115. doi:10.1016/j.yebeh.2020.107639
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  Introduction: Patients presenting to the pediatric emergency department (ED) often undergo unnecessary testing that leads to prolonged ED visits. Lower ED length of stay has been linked to improved patient experience and may reduce ED overcrowding, a costly burden on a health system. Methods: This is a retrospective cohort study involving patient records over the period of 6 months at an urban tertiary children's hospital who presented with seizures. Febrile seizures, seizures associated with trauma, and charts of patients who did not present initially through our ED were excluded. Results: 328 charts were obtained through this search criteria. Head imaging was performed in 52 (16%) patients and consisted of 81% CT (n = 42) and 19% (n = 10) magnetic resonance imaging (MRI). Obtaining an MRI was associated with a 3.5 h longer ED visit (p = 0.07); obtaining a CT was associated with a 1.5 h longer ED visit (p = 0.005). An Electroencephalogram (EEG) was obtained for 67 (20%) visits and was associated with a 3.0 h longer ED length of stay (p < 0.001). Ten % of the CT scans showed new or progressive findings and 40% of the MRIs done provided useful information for management. Thirty-seven % of EEGs performed in new onset seizure patients revealed epileptiform findings and 5% of EEGs in established seizure patients provided meaningful findings important to management. Conclusion: Obtaining neurodiagnostic studies significantly prolongs duration of stay in the ED. Electroencephalograms appear to have the greatest yield in new onset seizure patients and can help make a diagnosis of an epilepsy syndrome in children.
• Eksambe, P., Shah, Y., Edelstein, A., & Kothare, S. (2020). Pleural Effusion Associated With Use of Lamotrigine. Pediatric Neurology, 104. doi:10.1016/j.pediatrneurol.2019.11.005
• Eksambe, P., Shah, Y., Singh, K., Stennett, J., Lauretta, E., Sy-Kho, R., Kim, J., Ascher, C., Karkare, S., & Kothare, S. (2020). Quality improvement strategies improve pediatric neurology inpatient discharges before noon. Neurology: Clinical Practice, 10(3). doi:10.1212/CPJ.0000000000000715
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  BackgroundEarly hospital discharge is an important quality improvement (QI) measure that has not been well studied in pediatric neurology. The objective of our study was to implement strategies to improve hospital discharge times for patients admitted to the pediatric neurology service.MethodsThis was a pilot QI study of hospital discharge before noon (DBN) in pediatric neurology patients admitted to a tertiary care children's hospital. The study duration was 6 months (12/2017-05/2018) - first 3 months preintervention and next 3 months postintervention. Strategies focusing on preidentifying MRI candidates and those needing home care services, identifying pharmacy preference, reviewing overnight video EEGs first thing in the morning, and implementing morning huddles, etc., were implemented. Demographic and clinical data were collected, including age, sex, race, and reasons for delay in discharge. Chi-square, t test, and survival analysis (log-rank test) were performed to determine differences between baseline and post-QI implementation.ResultsOne hundred ninety-one patients were included in the study. There were 76 participants before the implementation of the study and 115 participants during the study. DBN percentage increased in the intervention period, from a baseline of 40.7% to 60.8%. Survival analysis showed that the discharge time after QI implementation improved significantly (p = 0.043).ConclusionsOur study successfully identified the factors associated with late discharge and developed effective strategies to improve DBN in an inpatient pediatric neurology setting.
• Shah, Y., Eksambe, P., Fomani, K., Louie, J., Shefali, K., & Kothare, S. (2020). Feasibility & safety of plasma exchange in paediatric neuro-immunology: A single center experience. European Journal of Paediatric Neurology, 27. doi:10.1016/j.ejpn.2020.04.001
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  Background: There is limited data available on the safety of therapeutic plasma exchange (TPE) for paediatric neuro-immunological disorders (PNID). In this study, we report our data on safety and feasibility of TPE for these disorders. Methods: Retrospective chart review was performed to include all patient who received TPE for four major PNID conditions: autoimmune encephalitis (AIE), acute disseminated encephalomyelitis (ADEM), Neuromyelitis optic spectrum disorder (NMOSD) and transverse myelitis (TM). We recorded minor and major adverse effects (AEs) associated with each TPE procedure. Secondary analysis also looked at the efficacy data of TPE on these patients. Results: Thirty-two patients with PNID received a total of 186 TPE cycles. Out of these, only 1 cycle (0.89%) in AIE subgroup, 1 (4.3%) in NMOSD and 1 (4.5%) in TM had adverse effects. No patients had major side effects. Conclusion: TPE was safe and well tolerated in our PNID patients.