Pediatric Critical Care Medicine最新文献

{"title":"Discontinuation of Routine Surveillance Cultures During Extracorporeal Membrane Oxygenation in Pediatric Patients: A Single-Center \"Before Versus After\" Experience, 2022-2025.","authors":"Ethan L Gillett, Chapel N Shults, Ashley L Lynch, Franscesca Miquel Verges, Matthew P Malone","doi":"10.1097/PCC.0000000000003967","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003967","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate our \"before vs. after\" change in practice of stopping routine surveillance cultures in pediatric patients supported with extracorporeal membrane oxygenation (ECMO), by examining patient outcomes, reviewing antimicrobial prescription, and costs.</p><p><strong>Design: </strong>Retrospective before vs. after study.</p><p><strong>Setting: </strong>PICU, neonatal ICU, and cardiac ICU in a quaternary children's hospital.</p><p><strong>Patients: </strong>Critically ill patients younger than 18 years supported on ECMO between October 2022 and March 2025.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Patients supported on ECMO in the 12 months following the practice change in March 2024 were compared with the same number of ECMO patients from before the practice change (47 in each group). Removal of routine daily blood culture and every-other-day urine and respiratory culture orders in ECMO order sets was associated with a reduction in cultures obtained: from mean (sd) 1.8 (± 0.22) to 0.4 (± 0.19) per ECMO day (p < 0.0001). We failed to identify an associated change in average ECMO run duration (211 vs. 181 hr; p = 0.48) or 30-day mortality (15/47 vs. 15/47). There was an associated decrease in antimicrobial prescriptions, quantified as a percentage of all ECMO days with prescription: (366/414 [88%] vs. 247/356 [69%]; mean difference, 19% [95% CI of the difference 13-25%]; p = 0.002). We estimate that using 2024 prices, there was a cost reduction of $136,000 in the 12 months following the change in practice.</p><p><strong>Conclusions: </strong>Our experience of introducing in March 2024 a change in using surveillance or scheduled cultures in pediatric ECMO patients in our center is that there was an associated reduction in microbiology cultures, improved antimicrobial stewardship, and cost-savings. In comparison with our experience before the change in practice, we failed to identify any associated negative effects such as increased duration of ECMO support or 30-day survival.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular Arrhythmias During Extracorporeal Circulatory Support for Cardiac Indications: Outcomes in a Single-Center Retrospective Cohort, 2020-2023.","authors":"William F Patten, Eric S Silver, Eva W Cheung","doi":"10.1097/PCC.0000000000003958","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003958","url":null,"abstract":"<p><strong>Objectives: </strong>Venoarterial extracorporeal membrane oxygenation (ECMO) can be used for pediatric patients in heart failure because of congenital or acquired heart disease. Even though these patients are at risk of arrhythmias, data are limited regarding the prevalence and types of arrhythmias, and their association with adverse outcomes. We present our single-center experience of arrhythmia during pediatric cardiac ECMO support, and the associated outcomes.</p><p><strong>Design: </strong>Single-center, retrospective cohort, 2020-2023.</p><p><strong>Setting: </strong>Cardiac ICU in a quaternary care center in New York.</p><p><strong>Patients: </strong>Pediatric patients requiring ECMO for cardiac indications, including extracorporeal cardiopulmonary resuscitation, cardiogenic shock, hypoxemia secondary to lack of pulmonary blood flow, or inability to wean from cardiopulmonary bypass.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified 74 patients undergoing 83 ECMO runs during 2020-2023. Arrhythmias occurred in 27 of 83 ECMO runs (33% [95% CI, 23-44%]), including ventricular arrhythmias in 14 of 83 runs (17%). We did not identify an association between any arrhythmia while on ECMO support and death or heart transplantation. However, ventricular arrhythmias were associated with greater hazard (using hazard ratio [HR]) of death or heart transplantation (HR, 5.7 [95% CI, 1.2-27.8]; p = 0.03). Similarly, we failed to identify an association between any arrhythmia on ECMO and wean failure (p = 0.09); however, ventricular arrhythmias on ECMO were associated with greater hazard of wean failure (HR, 18.8 [95% CI, 2.9-121]; p = 0.002). Any arrhythmia on ECMO was also associated with longer ECMO duration (189 vs. 90.1 hr; p < 0.001), particularly ventricular arrhythmias (335 vs. 94 hr; p < 0.001).</p><p><strong>Conclusions: </strong>In our 2020-2023, single-center experience in pediatric cardiac cases requiring venoarterial ECMO support for cardiac failure, the prevalence of arrhythmias was substantial (one-in-three ECMO runs). Of note, ventricular arrhythmias on ECMO were associated with greater hazard of transplant-free survival, ECMO wean failure, and prolonged ECMO duration.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing the Timing and Integration of MRI-Based Prognostication After Pediatric Cardiac Arrest.","authors":"Sumiko Sasaki, Takeshi Namba, Mitsuaki Nishikimi, Shinichiro Ohshimo, Nobuaki Shime","doi":"10.1097/PCC.0000000000003947","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003947","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Risk of Chronic Kidney Disease After Continuous Renal Replacement Therapy in Critically Ill Children: Single-Center PICU Cohort in Sweden, 2008-2021.","authors":"Isabelle E Szeps, Maria Herthelius, Åke Norberg, Samuel Wiqvist, Anna L Granström, Urban Fläring, Andreas Andersson","doi":"10.1097/PCC.0000000000003966","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003966","url":null,"abstract":"<p><strong>Objective: </strong>Continuous renal replacement therapy (CRRT) is the preferred method of kidney support for critically ill children with severe acute kidney injury (AKI) or fluid overload (FO). The number of survivors after pediatric CRRT is increasing, but there are insufficient data describing the risk of developing chronic kidney disease (CKD) in these patients.</p><p><strong>Design: </strong>A register-based study from a tertiary multidisciplinary hospital, 2008-2021.</p><p><strong>Setting: </strong>PICU patients 18 years or younger treated with CRRT due to AKI or FO at Karolinska University Hospital from 2008 to 2021 were included. Detailed PICU data from PICU survivors were combined with data from the Swedish National Patient Register aiming to investigate the long-term risk of CKD development. Secondary outcomes included risk of hypertension, end-stage renal disease and mortality.</p><p><strong>Intervention: </strong>None.</p><p><strong>Measurements and main results: </strong>We identified and included 156 PICU survivors with a mean follow-up time of 6.4 years (sd 3.2). CKD developed in 19 of 156 (12.2%) patients, resulting in an incidence of 18.9 (95% CI, 11.4-29.6) cases per 1000 person-years. Median time to CKD diagnosis was 11.5 months (interquartile range 3-62.5). Hypertension occurred in 17 of 156 patients (10.9%), and the composite outcome of CKD or hypertension in 28 of 156 patients (17.9%). The incidence of post-PICU mortality was 6 per 1000 person-years (95% CI, 2.2-13.1). In multivariable analysis, CRRT duration (p = 0.02) and estimated glomerular filtration rate (eGFR) at hospital discharge (p = 0.02) were associated with CKD development. We failed to identify an association between age at CRRT initiation or PICU illness and subsequent development of CKD.</p><p><strong>Conclusions: </strong>In our center in Sweden, 2008-2021, we found that a significant proportion of children surviving critical illness requiring CRRT are subsequently diagnosed with CKD or hypertension over time, demonstrating that rigorous follow-up of PICU patients undergoing CRRT is warranted.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocolized Evaluation of Permissive Blood Pressure Targets Versus Usual Care (PRESSURE): Statistical Analysis Plan for the PRESSURE Trial.","authors":"Tommaso Viola, Julia Broomhall, Zia Sadique, Paul Mouncey, David A Harrison, David P Inwald","doi":"10.1097/PCC.0000000000003961","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003961","url":null,"abstract":"<p><strong>Objective: </strong>To describe the prespecified analysis plan for Protocolized Evaluation of Permissive Blood Pressure Targets vs. Usual Care (PRESSURE), a trial comparing a permissive mean arterial pressure (MAP) target above the age-specific fifth centile with usual care in critically ill children.</p><p><strong>Design: </strong>Pragmatic, open, multicenter, parallel group randomized controlled trial with integrated economic evaluation.</p><p><strong>Setting: </strong>Twenty-one PICUs in the United Kingdom.</p><p><strong>Patients: </strong>Infants and children older than 38 weeks corrected gestational age to 16 years, accepted to a participating PICU, on invasive mechanical ventilation (IMV) and receiving vasoactive drugs for hypotension.</p><p><strong>Intervention: </strong>Adjustment of hemodynamic support to achieve a permissive MAP target greater than the fifth centile for age during IMV.</p><p><strong>Measurements and main results: </strong>The primary outcome is a composite 30-day mortality and duration of IMV, and it will be analyzed with a two-sample rank-sum test. Components will also be analyzed separately. Sensitivity analyses will adjust for adherence, and subgroup analyses will test interactions with baseline covariates. Secondary analyses will compare mortality at various time-points, duration of survival, time to liberation from IMV, functional status changes, receipt of renal replacement therapy and length of stay. The health economic analysis will follow the intention-to-treat principle and report the mean (95% CI) incremental costs, quality-adjusted life years and cost-effectiveness up to 12 months.</p><p><strong>Conclusions: </strong>Results will be reported following this plan through peer-reviewed publications and conference presentations.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Reliability and Timeliness of Appropriate Genetic Counseling Consultation in the Pediatric Cardiac ICU: Single-Center Quality Improvement Study, 2020-2024.","authors":"Briana L Sawyer, Melanie Emmerson, Jennifer Marietta, Joshua Kawasaki, Brittany Kent, Ivana Grbelja, Judson Moore","doi":"10.1097/PCC.0000000000003955","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003955","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiovascular genetics evaluation in the cardiac ICU (CICU) is essential for patient and family care. However, engaging genetic counseling (GC) consultation by frontline care teams in the CICU is challenging. This quality improvement (QI) project aimed to: 1) increase GC consultations for eligible CICU patients, 2) decrease time from admission to consultation, and 3) assess whether changes aligned with parental preferences.</p><p><strong>Design: </strong>Single-center QI study, from January 2020 to June 2024.</p><p><strong>Setting: </strong>Large tertiary care children's hospital in the United States.</p><p><strong>Patient cohort: </strong>Two hundred sixty-five patients with congenital heart defect (CHD).</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>In 2022, we introduced a standardized admission process for admissions with CHD, including: electronic medical record (EMR) notifications, accurate diagnostics, improved referral workflow and collaboration with fetal cardiology clinic, and parent surveys. A before-vs.-after analysis showed an associated increase in GC consultation from 76% to 94%; the mean time from admission to consultation decreased from 6 to 3 days. Post-introduction, there was reduced variability and less delay compared with pre-implementation. A needs assessment survey via a parent-support group had 151 responses, which indicated that 83% of families wanted genetic testing. Sixty-nine percent of families wanted to discuss genetic testing through in-person consultation during their child's initial inpatient admission. Thirty-two percent of families preferred contact as soon as possible and 47% preferred contact before cardiac surgery. Last, 75% of parents with a fetal diagnosis of CHD expressed interest in discussing testing while pregnant.</p><p><strong>Conclusions: </strong>In our pre- vs. post-introduction of a QI intervention, we found that eligible CICU patients are more reliably and promptly identified for GC consultation by leveraging the EMR and partnering with CICU staff and fetal cardiology. Parents supported genetic testing, typically delivered through integrated GC consultations in both the fetal and inpatient settings.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What We Have Got Here Is Failure to Communicate.","authors":"Thomas A Nakagawa, Joe Brierley","doi":"10.1097/PCC.0000000000003953","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003953","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Large Language Model Approach to Functional Status Scale Assessment.","authors":"Blake Martin, Anna M Janas, Kristen R Miller, Sara J Deakyne Davies, Tellen D Bennett, Aline B Maddux","doi":"10.1097/PCC.0000000000003916","DOIUrl":"10.1097/PCC.0000000000003916","url":null,"abstract":"<p><strong>Objectives: </strong>To develop a fine-tuned version of the generative pretrained transformer (GPT)-4o artificial intelligence (AI) model able to estimate Functional Status Scale (FSS) scores among critically ill children.</p><p><strong>Design: </strong>Secondary analysis of a prospective, observational cohort of critically ill children 1 month to 18 years old who required invasive mechanical ventilation for greater than or equal to 3 days. Four patient notes from each of three hospitalization timepoints-baseline (history & physical), PICU transfer, and hospital discharge-along with retrospectively assigned FSS scores were used to train the model. The resulting custom GPT (hereafter, FSS-AI) was then applied to the remaining 428 notes. The GPT-generated FSS scores were then compared with the manually assigned scores determined prospectively during the original study.</p><p><strong>Setting: </strong>A single, quaternary-care academic pediatric hospital.</p><p><strong>Patients: </strong>Children who completed the original study, survived to discharge, and had FSS scores documented.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>FSS-AI analyzed 428 notes from 147 patients over 255 minutes (averaging 35.7 s/note). FSS-AI demonstrated moderate agreement with manually determined total FSS scores at the pre-illness baseline (weighted Cohen's Kappa, 0.59; 95% CI, 0.49-0.70) and hospital discharge (0.51; 95% CI, 0.43-0.58) timepoints, with slightly lower agreement at PICU transfer (0.45; 95% CI, 0.37-0.54). For discrimination of normal total FSS scores (6-7) from abnormal scores (≥ 8), FSS-AI accuracy and positive predictive value were highest at the pre-illness baseline (0.90 and 0.95, respectively) and hospital discharge (0.81-0.75) timepoints. FSS-AI identified children with a new morbidity at hospital discharge (total FSS increase ≥ 3 or domain FSS increase ≥ 2) with accuracy and sensitivity of 0.75 and 0.56.</p><p><strong>Conclusions: </strong>A custom version of GPT-4o was able to estimate FSS scores at multiple hospitalization timepoints. The tool demonstrated moderate agreement with manually determined scores, could discriminate children with normal vs. abnormal FSS (best performance at baseline and hospital discharge timepoints), and had fair accuracy for detecting new morbidities present at hospital discharge.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"586-595"},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Offering a Potential Route to Better Neonatal ICU to PICU Transitions.","authors":"Peter J Davis","doi":"10.1097/PCC.0000000000003940","DOIUrl":"10.1097/PCC.0000000000003940","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"684-686"},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147468517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Albumin Infusion With Differential Response in Pediatric Sepsis and Septic Shock: Retrospective Analysis Using a U.S. Multicenter 2012-2018 Dataset.","authors":"Cheolmin Matthew Lee, Mihir R Atreya, Tellen D Bennett, Reid W D Farris, E Vincent S Faustino, Jaime Fernandez Sarmiento, Alon Geva, Mark Hall, Colin Rogerson, Sareen Shah, L Nelson Sanchez-Pinto","doi":"10.1097/PCC.0000000000003933","DOIUrl":"10.1097/PCC.0000000000003933","url":null,"abstract":"<p><strong>Objective: </strong>The study goal was to evaluate the outcomes associated with albumin use in children with sepsis and shock compared with those without shock, using causal inference analysis in a multicenter cohort.</p><p><strong>Design, setting, and patients: </strong>This was a secondary analysis of electronic health record data collected from 13 U.S. PICUs between 2012 and 2018, consisting of children younger than 18 years who met Phoenix sepsis criteria within the first 24 hours of PICU admission.</p><p><strong>Interventions: </strong>Covariate-balancing propensity score weighting was applied to adjust for indication bias in the albumin use. Patients receiving at least 0.5 g/kg albumin within 24 hours of PICU admission were assigned to the albumin group; others to the control. Only 24-hour survivors were included to address immortal time bias.</p><p><strong>Measurements and main results: </strong>Overall, 17,307 children with sepsis survived at least 24 hours. Of these, 1,344 patients (7.8%) who received albumin within the first 24 hours, and 9,678 (55.9%) met the criteria for septic shock. A significant interaction between albumin use and shock status was observed (interaction: -0.353, p = 0.007), with albumin administration in pediatric septic shock patients associated with lower in-hospital mortality: odds ratio equals to 0.698 (95% CI, 0.629-0.774), risk ratio equals to 0.746 (95% CI, 0.625-0.891), and hazard ratio equals to 0.688 (95% CI, 0.558-0.848). In contrast, there was no difference in outcomes between the albumin and control groups in the non-shock group.</p><p><strong>Conclusions: </strong>Early albumin administration was associated with improved outcomes in children with septic shock, but not in those without shock. These results highlight the importance of considering clinical heterogeneity, such as the presence of shock, in identifying treatment-responsive subgroups and enabling more targeted interventions in pediatric sepsis. Further prospective validation is warranted.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"625-633"},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}