JAMA Pediatrics最新文献

{"title":"Evidence-Informed Quality Indicators for Pediatric Trauma Care.","authors":"Lynne Moore, Natalie L Yanchar, Pier-Alexandre Tardif, Matthew Weiss, Emilie Beaulieu, Antonia Stang, Isabelle Gagnon, Belinda Gabbe, Thomas Stelfox, Ian Pike, Alison Macpherson, Simon Berthelot, Terry Klassen, Suzanne Beno, Sasha Carsen, Mélanie Labrosse, Roger Zemek, Fran Priestap, Brett Burstein, Katherine E Remick, Keith Owen Yeates, Neil Merritt, Nathan Kuppermann, Ruth Loellgen, Naomi Davis, Fiona Lecky, Warwick Teague, Andrew Holland, Christian Malo, Marianne Beaudin, Patrick Archambault, Gabrielle Freire","doi":"10.1001/jamapediatrics.2025.0036","DOIUrl":"10.1001/jamapediatrics.2025.0036","url":null,"abstract":"<p><strong>Importance: </strong>Despite the unique physiological characteristics and health care needs of pediatric trauma patients, there is a lack of quality indicators (QIs) based on pediatric-specific evidence to support quality improvement in this population.</p><p><strong>Objective: </strong>To develop a consensus-based set of QIs for acute pediatric trauma care that considers evidence on effectiveness, safety, cost-effectiveness, equity, and caregiver perspectives and is applicable in pediatric and nonpediatric trauma centers.</p><p><strong>Design, setting, and participants: </strong>A modified Research and Development (RAND)/University of California Los Angeles (UCLA) expert consensus study was conducted consisting of an online survey and a virtual workshop, led by an independent moderator. Panelists represented key areas of pediatric trauma patient management, diverse care settings (from level I pediatric trauma centers to level III referring centers), 5 high-resource countries, and caregivers. Data were analyzed from May to August 2024.</p><p><strong>Exposure: </strong>Likert-scale ratings of 41 QIs.</p><p><strong>Main outcomes and measures: </strong>Panelists rated 41 QIs on a 7-point Likert scale according to 4 criteria: importance, supporting evidence, actionability, and measurability. QIs with a global score of 24 of 28 or greater and an importance score of 6 of 7 or greater were considered accepted by consensus.</p><p><strong>Results: </strong>A total of 65 experts were invited, of whom 59 accepted (91%; 25 over 50 years of age [44.7%]; 34 female [60.7%]), 56 (95%) completed the first round, and 54 (92%) completed both rounds. Twenty-three QIs were selected covering key areas of acute pediatric trauma management (eg, transfer to a pediatric trauma center for neurotrauma or major multisystem trauma, documentation of vital signs, early rehabilitation, nutritional support), the most common types of injuries (eg, hypertonic saline in severe traumatic brain injury, stabilization of femoral shaft fractures, nonoperative management of solid organ injuries), value in care (eg, imaging in children at low risk on a clinical decision rule), patient-centered care (eg, designated support person, caregiver presence), and equity (eg, mental health screening).</p><p><strong>Conclusions: </strong>These results may be used by trauma quality improvement programs in high-resource countries to select context-specific quality indicators to improve the effectiveness, safety, cost-effectiveness, equity, and patient-centered nature of pediatric trauma care.</p>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Divergent State Legislation for Adolescent Chest Surgeries.","authors":"Paola R Vidal-Espinoza, Jay Y Taimish, Jack L Turban","doi":"10.1001/jamapediatrics.2025.0128","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0128","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":""},"PeriodicalIF":24.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Traumatic Brain Injury and Social Determinants of Health","authors":"Vincy Chan, Clarissa Serafine Wirianto, Robert Balogh, Juliet Haarbauer-Krupa, Michael David Escobar","doi":"10.1001/jamapediatrics.2025.0143","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0143","url":null,"abstract":"This cohort study examines incident and subsequent health care visits associated with traumatic brain injury and stratified by social determinants of health.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"49 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Growth in US Neonatal Intensive Care Capacity and Mortality, 1991-2020","authors":"Gwenyth M. Gasper, Patrick M. Stuchlik, Therese A. Stukel, David C. Goodman","doi":"10.1001/jamapediatrics.2024.7133","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2024.7133","url":null,"abstract":"ImportanceThe effectiveness of neonatal intensive care in very ill newborns has led to rapid growth in US neonatal intensive care unit (NICU) capacity that is uncorrelated with regional perinatal risk. It is not known if there is an association between growth of regional capacity and newborn mortality.ObjectiveTo estimate the association between change in NICU capacity and neonatal mortality across 246 neonatal intensive care regions.Design, Setting, and ParticipantsIn this repeated cross-sectional study of US infants, the association between change in regional capacity and mortality was estimated in the years 1991, 2003, 2007, 2012, 2017, 2018, 2019, and 2020 using Poisson generalized estimating equations models adjusted for maternal and newborn characteristics, with newborns as the units of analysis. Data were analyzed June 30, 2024. This study used a 25% sample of all US infants born live with a birth weight of 400 g or more and gestational age of between 22 and less than 45 weeks (N = 30 902 221 newborns).ExposureChange in regional NICU capacity, measured as both counts of neonatologists and staffed NICU beds per 1000 live births (LBs) from 1991 to the birth year.Main Outcomes and MeasuresThe primary outcome was neonatal (&amp;amp;lt;28 days) mortality and the secondary outcome was 180-day mortality.ResultsFrom 1991-2020, total adjusted neonatologists and NICU beds per 1000 LBs increased from 0.44 to 1.44 (227%) and 5.43 to 8.02 (48%), respectively, while neonatal mortality decreased from 3.87 to 2.21 (−43%) and 180-day mortality decreased from 6.27 to 3.19 (−49%) per 1000 LBs. There was no meaningful correlation between change in regional capacity (neonatologists: <jats:italic>r</jats:italic>, −0.12; 95% CI, −0.25 to 0.00; NICU beds: <jats:italic>r</jats:italic>, −0.07; 95% CI, −0.19 to 0.06) and change in regional neonatal mortality. No meaningful associations with capacity were observed in multilevel models (neonatologists: adjusted relative rate [aRR], 1.01; 95% CI, 0.93-1.01; NICU beds: aRR, 1.00; 95% CI, 0.99-1.00) nor was 180-day mortality associated with capacity. No associations were observed in birth cohorts stratified by relative need based on gestational age, maternal education, or maternal race or ethnicity.Conclusions and RelevanceIn this cross-sectional study, growth in regional NICU capacity was not associated with observable mortality benefit. Additional studies are needed to investigate the costs and benefits associated with NICU care expansion.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"61 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143678198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-Specific Trends in Pediatric and Adult Firearm Homicide After the Onset of the COVID-19 Pandemic","authors":"Jonathan Jay, Patrece L. Joseph, Jason E. Goldstick","doi":"10.1001/jamapediatrics.2025.0136","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0136","url":null,"abstract":"This cross-sectional study examines age-specific trends in firearm violence among children and adults in the US after the onset of the COVID-19 pandemic.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"57 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143678199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neural Development, Music Therapy, and Active Noise Control in the NICU—No Preterm Neonate Needs Mozart","authors":"Artur C. Jaschke","doi":"10.1001/jamapediatrics.2025.0125","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0125","url":null,"abstract":"This Viewpoint describes intrauterine and extrauterine auditory brain development and advocates for use of music therapy for preterm neonates in the neonatal intensive care unit (NICU).","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"46 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143678182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethics in the Age of Consortia","authors":"Kate Keenan","doi":"10.1001/jamapediatrics.2025.0059","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0059","url":null,"abstract":"This Viewpoint outlines some of the challenges of protecting human participants in multisite studies with a single institutional review board and recommends the development of increased guidance to protect participants.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"9 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143678179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenotonsillectomy and Health Care Utilization in Children With Snoring and Mild Sleep Apnea","authors":"Jessie P. Bakker, Fang Zhang, Raouf Amin, Cristina M. Baldassari, Ronald D. Chervin, Susan L. Garetz, Fauziya Hassan, Sally Ibrahim, Stacey L. Ishman, Erin M. Kirkham, Ariel Linden, Ron B. Mitchell, Kamal Naqvi, Carol L. Rosen, Kristie Ross, Ignacio E. Tapia, Lisa R. Young, Phoebe K. Yu, Susan Redline, Rui Wang","doi":"10.1001/jamapediatrics.2025.0023","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0023","url":null,"abstract":"ImportanceThe literature indicates that health care utilization (HCU) of children with untreated moderate-to-severe obstructive sleep apnea is greater than that of matched controls before diagnosis, and treatment is associated with a decline in HCU not observed in those who remain untreated. Research on this topic has been limited to retrospective analyses and observational cohort studies; little is known about HCU among the many children with snoring and mild sleep-disordered breathing (SDB).ObjectiveTo determine whether adenotonsillectomy in comparison with watchful waiting with supportive care is associated with fewer health care encounters and prescriptions.Design, Setting, and ParticipantsThis randomized clinical trial, Pediatric Adenotonsillectomy Trial for Snoring (PATS), was a 12-month, parallel-arm trial conducted from 2016 to 2022 in tertiary care centers in the United States. Participants were recruited from otolaryngology, sleep, pulmonary, or general pediatric clinics; aged 3 to 13 years; diagnosed with mild SDB; had a tonsillar hypertrophy grade of 2 or more; and had a body mass index <jats:italic>z</jats:italic> score less than 3. Children referred from a clinician outside of the local electronic medical record system were excluded. Data analysis was conducted from June 2022 to April 2024.InterventionEarly adenotonsillectomy.Main Outcomes and MeasuresEvaluation of HCU was a prespecified secondary aim of PATS. Total encounters and total prescriptions over the 12 months after randomization were analyzed.ResultsAmong 459 children who were randomized, the analytic sample included 381 children, after excluding those referred from outside the local electronic medical record system. The median (IQR) age was 6 (4-8) years; 192 participants (50%) were female and 189 (50%) male. Adenotonsillectomy was associated with a 32% reduction in total health care encounters (mean difference, −1.25 per participant per year; 95% CI, −1.96 to −0.53) and a 48% reduction in prescriptions (mean difference, −2.53 per participant per year; 95% CI, −4.12 to −0.94). The difference in encounters was primarily driven by fewer office visits and outpatient procedures rather than by reduced hospitalizations or urgent care visits.Conclusions and RelevanceThis study found that adenotonsillectomy was associated with reduced all-cause HCU in children with mild SDB, supporting early intervention for children with mild SDB. Future research focused on the cost effectiveness of adenotonsillectomy for pediatric SDB is warranted.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT02562040\">NCT02562040</jats:ext-link>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"39 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Artificial Intelligence Can Promote Inclusive Health","authors":"Dimitri A. Christakis, Jacob Neely, Wyatt Spalding, Douglas J. Opel","doi":"10.1001/jamapediatrics.2025.0096","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0096","url":null,"abstract":"This Viewpoint explores the potential utilities of artificial intelligence for achieving inclusive health care for people with intellectual and developmental disabilities.","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"20 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored Adherence Incentives for Childhood Asthma Medications","authors":"Chén C. Kenyon, William O. Quarshie, Rui Xiao, Mishaal Yazdani, Carina M. Flaherty, G. Chandler Floyd, Victoria A. Miller, Tyra C. Bryant-Stephens, Joseph J. Zorc, Chris Feudtner","doi":"10.1001/jamapediatrics.2025.0010","DOIUrl":"https://doi.org/10.1001/jamapediatrics.2025.0010","url":null,"abstract":"ImportanceDifferential adherence to efficacious preventive medications is one potentially modifiable driver of racial disparities in childhood asthma outcomes.ObjectiveTo determine the effect of a financial incentive-enhanced intervention on adherence to inhaled asthma preventive medication in a high-risk, predominantly racially minoritized cohort of children with asthma.Design, Setting, and ParticipantsThis was a randomized clinical trial conducted from September 2019 through June 2022 at a large mid–Atlantic pediatric health system in the US. Children were eligible if they were between 5 and 12 years old, prescribed a preventive inhaler for daily use, and had at least 2 asthma exacerbations requiring systemic steroids in the preceding year. Data were analyzed from December 2022 to December 2024.InterventionInhaled medication use was monitored using electronic inhaler sensors over a 7-month period. Families who completed a 1-month run-in interval were randomized to 1 of 3 arms for a 3-month experiment interval: (1) daily text message medication reminders, weekly adherence feedback, and gain-framed, financial incentives of up to $1 per day (full intervention); (2) daily text message medication reminders and weekly adherence feedback (hybrid intervention); or (3) no reminders, feedback, or incentives (active control). Medication adherence monitoring then continued for a 3-month observation interval, where all arms reverted to active control conditions.Main Outcomes and MeasuresThe primary outcome was adherence to inhaled maintenance medication during the experiment; secondary outcomes included adherence during the observation phase. The study was powered to detect a difference in average monthly adherence between the full intervention and active control condition.ResultsOf the 106 children randomized, 99 had at least 1 month of monitoring data (56 male [57%] and 43 female [43%]; mean [SD] age, 8.0 [2.3] years). Most participants (81 [82%]) identified as non-Hispanic Black and demographic and clinical characteristics were similar across study arms. During the experiment interval, participants receiving the full intervention had a 15–percentage point (95% CI, 2-29 percentage points) higher inhaled maintenance medication adherence compared with participants in the active control. There was no evidence of adherence differences in the observation interval.Conclusion and RelevanceWhile a financial incentive-enhanced mobile health intervention led to higher inhaled preventive medication adherence as compared with the active control group, there was no evidence for enduring effect after the intervention components ceased, consistent with other studies that include financial incentives to encourage behavior change.Trial RegistrationClinicalTrials.gov Identifier: &lt;jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT03907410?term=NCT03907410&amp;amp;amp;rank=1\"&gt;NCT03907410&lt;/jats:ext-lin","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":"55 1","pages":""},"PeriodicalIF":26.1,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}