Author Affiliations: Mayo Clinic College of Medicine (Dr Smith), and Department of Ophthalmology (Dr Mohney), Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
In reply
We wish to thank Liu and colleagues for their interest in our article on the incidence of pediatric Horner syndrome and risk of neuroblastoma.1 We assume that issues regarding our methodology stem from the inherent limitations of retrospective clinical studies. However, our methodology was both clearly described and consistent, and therefore does not affect the validity of our findings.
Our results, and those of other studies,2 - 4 suggest that obtaining imaging studies should not be considered the standard of care for pediatric patients with Horner syndrome manifesting at, or shortly after, documented trauma. Specifically, children whose syndrome appears following birth or other trauma, in addition to surgical trauma, do not need imaging studies, unless physical examination findings detect syndrome worsening.
In our cohort, a malignant tumor could not be definitively excluded in the 7 idiopathic cases and the 7 cases attributed to birth trauma; however, these cases had a mean follow-up of 68 months without the identification of an underlying mass lesion. The percentage of patients with idiopathic Horner syndrome who are found to have a previously undetected neuroblastoma5 - 6 or other malignancy is small,7 and the decision to subject all such children to imaging should be made with consideration for the potential drawbacks of imaging studies, including the risks of general anesthesia and radiation exposure.
In their letter, Liu and coauthors state that their study7 was free of referral bias because patients came to them without a prior diagnosis or evaluation. However, their population comprised those presenting to a tertiary care center and is therefore potentially biased toward children with more severe disease, unlike the population-based confines of the children residing in Olmsted County, Minnesota.
Finally, while many parents may desire imaging for their child when presented with the possibility of an underlying neoplasm, this was not universally the case in the study by Mahoney and coauthors,7 in which “some patients and parents refused” imaging studies. The findings of our study and others support our recommendation that a more judicious approach be used when approaching pediatric patients with Horner syndrome.2 - 4
Correspondence: Dr Mohney, Department of Ophthalmology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (mohney@mayo.edu).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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