{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T22:50:18Z","timestamp":1779231018727,"version":"3.51.4"},"reference-count":11,"publisher":"Walter de Gruyter GmbH","issue":"11","license":[{"start":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T00:00:00Z","timestamp":1602028800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jpem-2020-0376_abs_001_w2aab3b7c75b1b6b1aab1c15b1Aa\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Hypocalcemia following total thyroidectomy (TT) is relatively common. It may result in significant morbidity, prolonged hospital stay, and increased costs. Treatment with intravenous (IV) calcium gluconate may also carry significant risks. In pediatrics, management consensus guidelines are lacking.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2020-0376_abs_002_w2aab3b7c75b1b6b1aab1c15b2Aa\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>At Phoenix Children\u2019s Hospital, a team of pediatric endocrinologists, surgeons and otolaryngologists developed a clinical pathway for patients undergoing TT. It was a Quality Improvement (QI) project with the primary aim of decreasing IV calcium gluconate use from a baseline of 68% to less than 40% over 15\u00a0months. Secondary aims included reducing hypocalcemia and length of hospitalization. Interventions included sending weekly pathway reminder emails, starting pre-operative calcium, and pathway implementation into the electronic health record.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2020-0376_abs_003_w2aab3b7c75b1b6b1aab1c15b3Aa\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Twenty-seven patients underwent TT over 15\u00a0months. IV calcium gluconate use dropped to 48%. Hypocalcemia and length of hospitalization were 96% and 52.7\u00a0h (range 21.1\u2013115.7) respectively. Pathway adherence improved after targeted interventions. Eleven (73%) of the 15 patients whose post-operative parathyroid hormone (PTH) nadir was below 15\u00a0pg\/mL required IV calcium gluconate vs. two (17%) out of 12 with levels above this threshold.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2020-0376_abs_004_w2aab3b7c75b1b6b1aab1c15b4Aa\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Standardizing care allowed for objective outcome analysis. We learned that post-operative serum PTH level was the main risk factor for requiring IV calcium gluconate. Implementing the pathway as a QI project allows for revisions based on outcomes, ultimately resulting in a pathway that best utilizes our infrastructure to optimize care. Other pediatric institutions may face similar challenges and can potentially learn from our experience.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jpem-2020-0376","type":"journal-article","created":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T12:27:52Z","timestamp":1602073672000},"page":"1443-1448","source":"Crossref","is-referenced-by-count":4,"title":["A quality improvement project for managing hypocalcemia after pediatric total thyroidectomy"],"prefix":"10.1515","volume":"33","author":[{"given":"Rob","family":"Gonsalves","sequence":"first","affiliation":[{"name":"Phoenix Children\u2019s Hospital , Division of Endocrinology and Diabetes , Phoenix , AZ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramin","family":"Jamshidi","sequence":"additional","affiliation":[{"name":"Phoenix Children\u2019s Hospital , Division of Pediatric Surgery , Phoenix , AZ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorothee","family":"Newbern","sequence":"additional","affiliation":[{"name":"Phoenix Children\u2019s Hospital , Division of Endocrinology and Diabetes , Phoenix , AZ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Shaibi","sequence":"additional","affiliation":[{"name":"Arizona State University College of Nursing and Health Innovation , Center for Health Promotion and Disease Prevention , Phoenix , AZ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micah","family":"Olson","sequence":"additional","affiliation":[{"name":"Phoenix Children\u2019s Hospital , Division of Endocrinology and Diabetes , Phoenix , AZ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reeti","family":"Chawla","sequence":"additional","affiliation":[{"name":"Phoenix Children\u2019s Hospital , Division of Endocrinology and Diabetes , Phoenix , AZ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon H.","family":"Gnagi","sequence":"additional","affiliation":[{"name":"Phoenix Children\u2019s Hospital , Department of Otolaryngology , Phoenix , AZ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver J.","family":"Oatman","sequence":"additional","affiliation":[{"name":"Phoenix Children\u2019s Hospital , Division of Endocrinology and Diabetes , Phoenix , AZ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2020,10,7]]},"reference":[{"key":"2023040101055755847_j_jpem-2020-0376_ref_001_w2aab3b7c75b1b6b1ab2b1b1Aa","doi-asserted-by":"crossref","unstructured":"Baumgarten, HD, Bauer, AJ, Isaza, A, Mostoufi-Moab, S, Kazahaya, K, Adzick, NS. Surgical management of pediatric thyroid disease: complication rates after thyroidectomy at the Children\u2019s Hospital of Philadelphia high-volume Pediatric Thyroid Center. J Pediatr Surg 2019; 54: 1969\u201375. https:\/\/doi.org\/10.1016\/j.jpedsurg.2019.02.009.","DOI":"10.1016\/j.jpedsurg.2019.02.009"},{"key":"2023040101055755847_j_jpem-2020-0376_ref_002_w2aab3b7c75b1b6b1ab2b1b2Aa","doi-asserted-by":"crossref","unstructured":"Kundel, J, Thompson, G, Richards, M, Qiu, L, Xiu, L, Cai, Y, et al. Pediatric endocrine surgery: a 20-year experience at the Mayo clinic. J Clin Endocrinol Metabol 2014; 99: 399\u2013406. https:\/\/doi.org\/10.1210\/jc.2013-2617.","DOI":"10.1210\/jc.2013-2617"},{"key":"2023040101055755847_j_jpem-2020-0376_ref_003_w2aab3b7c75b1b6b1ab2b1b3Aa","doi-asserted-by":"crossref","unstructured":"Al-Qurayshi, Z, Hauch, A, Srivastav, S, Aslam, R, Friedlander, P, Kandil, E. A national perspective of the risk, presentation, and outcomes of pediatric thyroid cancer. JAMA Otolaryngol Head Neck Surg 2016; 142: 472\u20138. https:\/\/doi.org\/10.1001\/jamaoto.2016.0104.","DOI":"10.1001\/jamaoto.2016.0104"},{"key":"2023040101055755847_j_jpem-2020-0376_ref_004_w2aab3b7c75b1b6b1ab2b1b4Aa","doi-asserted-by":"crossref","unstructured":"Patel, NA, Bly, RA, Adams, S, Carlin, K, Parikh, SR, Dahl, JP, et al. A clinical pathway for the postoperative management of hypocalcemia after pediatric thyroidectomy reduces blood draws. Int J Pediatr Otorhinolaryngol 2018; 105: 132\u20137. https:\/\/doi.org\/10.1016\/j.ijporl.2017.12.011.","DOI":"10.1016\/j.ijporl.2017.12.011"},{"key":"2023040101055755847_j_jpem-2020-0376_ref_005_w2aab3b7c75b1b6b1ab2b1b5Aa","doi-asserted-by":"crossref","unstructured":"Jiang, W, Lee, E, Newfield, RS. The utility of intact parathyroid hormone level in managing hypocalcemia after thyroidectomy in children. Int J Pediatr Otorhinolaryngol 2019; 125: 153\u20138. https:\/\/doi.org\/10.1016\/j.ijporl.2019.07.006.","DOI":"10.1016\/j.ijporl.2019.07.006"},{"key":"2023040101055755847_j_jpem-2020-0376_ref_006_w2aab3b7c75b1b6b1ab2b1b6Aa","doi-asserted-by":"crossref","unstructured":"Yu, YR, Fallon, SC, Carpenter, JL, Athanassaki, I, Brandt, ML, Wesson, DE, et al. Perioperative determinants of transient hypocalcemia after pediatric total thyroidectomy. J Pediatr Surg 2017; 52: 684\u20138. https:\/\/doi.org\/10.1016\/j.jpedsurg.2017.01.011.","DOI":"10.1016\/j.jpedsurg.2017.01.011"},{"key":"2023040101055755847_j_jpem-2020-0376_ref_007_w2aab3b7c75b1b6b1ab2b1b7Aa","doi-asserted-by":"crossref","unstructured":"Chen, Y, Masiakos, PT, Gaz, RD, Hodin, RA, Parangi, S, Randolph, GW, et al. Pediatric thyroidectomy in a high volume thyroid surgery center: risk factors for postoperative hypocalcemia. J Pediatr Surg 2015; 50: 1316\u20139. https:\/\/doi.org\/10.1016\/j.jpedsurg.2014.10.056.","DOI":"10.1016\/j.jpedsurg.2014.10.056"},{"key":"2023040101055755847_j_jpem-2020-0376_ref_008_w2aab3b7c75b1b6b1ab2b1b8Aa","doi-asserted-by":"crossref","unstructured":"Agac, AA, Kutun, S, Cetin, A. Are the characteristics of thyroid cancer different in young patients? J Pediatr Endocrinol Metab 2014; 27: 497\u2013502. https:\/\/doi.org\/10.1515\/jpem-2013-0192.","DOI":"10.1515\/jpem-2013-0192"},{"key":"2023040101055755847_j_jpem-2020-0376_ref_009_w2aab3b7c75b1b6b1ab2b1b9Aa","doi-asserted-by":"crossref","unstructured":"Noordzij, JP, Lee, SL, Bernet, VJ, Payne, RJ, Cohen, SM, McLeod, IK, et al. Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies. J Am Coll Surg 2007; 205: 748\u201354. https:\/\/doi.org\/10.1016\/j.jamcollsurg.2007.06.298.","DOI":"10.1016\/j.jamcollsurg.2007.06.298"},{"key":"2023040101055755847_j_jpem-2020-0376_ref_010_w2aab3b7c75b1b6b1ab2b1c10Aa","doi-asserted-by":"crossref","unstructured":"Freire, AV, Ropelato, MG, Ballerini, MG, Acha, O, Bergad\u00e1, I, de Papendieck, LG, et al. Predicting hypocalcemia after thyroidectomy in children. Surgery 2014; 156: 130\u20136. https:\/\/doi.org\/10.1016\/j.surg.2014.02.016.","DOI":"10.1016\/j.surg.2014.02.016"},{"key":"2023040101055755847_j_jpem-2020-0376_ref_011_w2aab3b7c75b1b6b1ab2b1c11Aa","doi-asserted-by":"crossref","unstructured":"Lavelle, J, Schast, A, Keren, R. Standardizing care processes and improving quality using pathways and continuous quality improvement. Curr Treat Options Pediatr 2015; 1: 347\u201358. https:\/\/doi.org\/10.1007\/s40746-015-0026-4.","DOI":"10.1007\/s40746-015-0026-4"}],"container-title":["Journal of Pediatric Endocrinology and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyter.com\/view\/journals\/jpem\/33\/11\/article-p1443.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jpem-2020-0376\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jpem-2020-0376\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T18:08:38Z","timestamp":1680372518000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.1515\/jpem-2020-0376\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,7]]},"references-count":11,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,10,23]]},"published-print":{"date-parts":[[2020,11,26]]}},"alternative-id":["10.1515\/jpem-2020-0376"],"URL":"https:\/\/doi.org\/10.1515\/jpem-2020-0376","relation":{},"ISSN":["2191-0251","0334-018X"],"issn-type":[{"value":"2191-0251","type":"electronic"},{"value":"0334-018X","type":"print"}],"subject":[],"published":{"date-parts":[[2020,10,7]]}}}