Considering Tonsillectomy in Children: Interview with Dr. Jack L. Paradise, Paradise Criteria Creator

Dr. Jack L. Paradise

Jack L. Paradise, MD, now retired, was the medical director of the Ambulatory Care Center at the Children’s Hospital of Pittsburgh. He was also a professor in the pediatrics department at the University of Pittsburgh School of Medicine. Dr. Paradise’s primary research was focused on indications for tonsillectomy and adenoidectomy, and on the diagnosis, management, and clinical significance of otitis media.

Why did you develop the Paradise Criteria? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

When in pediatric practice in a new, union-sponsored health plan in Appalachia, I was often called upon to render judgment as to whether or not tonsillectomy was indicated for individual children for whom a recommendation for tonsillectomy had been made by other physicians. This procedure was instituted because health plan administrators believed that tonsillectomy often was being performed on children without appropriate indications. Accordingly, payment for tonsillectomy by the health plan was made contingent on prior approval by me or by another member of a health-plan-designated group of consultants. In that role, I came to realize that there were then no evidence-based criteria for tonsillectomy. Recommendations by recognized authorities varied widely and were based entirely on clinical experience and/or opinion. When I left practice to head an ambulatory care program in a large teaching hospital, I saw an opportunity to address the question of criteria for tonsillectomy systematically.

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Morbidity and Mortality in Children with Blunt Trauma: Interview with Dr. Shannon N. Acker, SIPA Score Creator

Dr. Shannon N. Acker

Shannon N. Acker, MD, is a pediatric surgeon at the University of Colorado. Dr. Acker’s primary research is focused on trauma and surgical complications in adolescents.

Why did you develop the SIPA? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

Children have a remarkable ability to compensate for hypovolemic shock and are able to maintain a normal blood pressure until they reach cardiovascular collapse. Because shock index incorporates not only blood pressure but also heart rate, we hypothesized that an age adjusted shock index would help us to identify these children before the point of cardiovascular collapse. Our motivation to create SIPA came from an ongoing desire to improve pediatric trauma care and our desire to more accurately identify severely injured children prior to the point of cardiovascular collapse.

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