Pediatric emergency care最新文献

{"title":"Accuracy of Visual Estimation of Left Ventricular Ejection Fraction Compared With Echocardiography in Children.","authors":"Seyfeddine Zayani, Farah Thabet, Abir Daya, Ikram Chamtouri, Cyrine Bennasrallah, Chokri Chouchane, Khaldoun Ben Hamda, Slaheddine Chouchane","doi":"10.1097/PEC.0000000000003349","DOIUrl":"10.1097/PEC.0000000000003349","url":null,"abstract":"<p><strong>Background: </strong>This study compared visual assessments of left ventricular systolic function in children by pediatric physicians with quantitative measurements using the Simpson method.</p><p><strong>Methods: </strong>This was a transverse, cohort study conducted between January and June 2023. Patient's echocardiography were performed by a certified pediatric cardiologist in the presence of 2 pediatricians: a senior pediatric intensivist (S.Z.) and a pediatric resident (A.D.). Both pediatricians had prior training in cardiac ultrasound. Following the visual assessment of the echocardiography, each pediatrician records their evaluation of the left ventricular ejection fraction (LVEF) as a percentage. We compared the visual assessment of LVEF with that obtained with quantitative measurements using the Simpson method by the pediatric cardiologist. Bland-Altman analysis was performed between the pediatrician and the cardiologist's LVEF evaluation. Besides the correlation coefficients ( r ) were calculated.</p><p><strong>Results: </strong>A total of 136 patients, aged between 0 and 18 years, were enrolled. The mean LVEF measured by the cardiologist was 65.05±14.15. The mean LVEF estimated by the senior pediatrician and the pediatric resident was 64.48±13.59 and 64.87±13.17, respectively. Strong correlations were found between visual estimates by both pediatricians and 2-dimensional LVEF ( r =0.832 and r =0.763 respectively, P <0.001). The bland-Altman plot showed that the mean difference of LVEF determined by 2-dimensional LVEF and eyeballing by a senior pediatric intensivist and the junior pediatrician was 0.57±3.64% and 0.18±4.37%, respectively.</p><p><strong>Conclusion: </strong>The study suggests that visual assessment of LVEF in children is reliable when conducted by experienced pediatricians familiar with echocardiography. However, the results of this study are primarily applicable to the assessment of normal or near-normal left ventricular function.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"359-364"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of ICD-10 Codes for Suicidal Ideation and Action in Pediatric Emergency Department Encounters.","authors":"Rena Xu, Louisa Bode, Alon Geva, Kenneth D Mandl, Andrew J McMurry","doi":"10.1097/PEC.0000000000003328","DOIUrl":"10.1097/PEC.0000000000003328","url":null,"abstract":"<p><strong>Objectives: </strong>According to the ideation-to-action framework of suicidality, suicidal ideation and suicidal action arise via distinct trajectories. Studying suicidality under this framework requires accurate identification of both ideation and action. We sought to assess the accuracy of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes for suicidal ideation and action in emergency department encounters.</p><p><strong>Methods: </strong>Accuracy of ICD-10-CM coding for suicidality was assessed through chart review of clinical notes for 205 emergency department encounters among patients 6-18 years old at a large academic pediatric hospital between June 1, 2016 and June 1, 2022. Physician notes were reviewed for documentation of past or present suicidal ideation, suicidal action, or both. The study cohort consisted of 103 randomly selected \"cases,\" or encounters assigned at least 1 ICD-10-CM code for suicidality, and 102 propensity-matched \"noncases\" lacking ICD-10-CM codes. Accuracy of ICD-10-CM codes was assessed using sensitivity, specificity, positive predictive value, and negative predictive value.</p><p><strong>Results: </strong>Against a gold standard chart review, the positive predictive value for ICD-10-CM suicidality codes was 86.9% (95% confidence interval [CI]: 84.5%-89.3%), and the negative predictive value was 76.2% (95% CI: 73.2%-79.2%). Nearly half of encounters involving suicidality were not captured by ICD-10-CM coding (sensitivity = 53.4%; 95% CI: 49.9%-56.9%). Sensitivity was higher for ideation-present (82.4%, 95% CI: 77.7%-87.1%) than for action-present (33.7%, 95% CI: 27.9%-39.5%) or action-past (20.4%, 95% CI: 15.5%-25.3%).</p><p><strong>Conclusions: </strong>Many cases of suicidality may be missed by relying on only ICD-10-CM codes. Accuracy of ICD-10-CM codes is high for suicidal ideation but low for action. To scale the ideation-to-action model for use in large populations, better data sources are needed to identify cases of suicidal action.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"378-382"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142896408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Difficult Intravenous Access Scores in a Low-Resource Setting: An External Validation Study.","authors":"Panida Kanjanauptom, David Kessler, Sirin Khongjaroensakun, Suphalak Darunaitorn, Worapant Kriengsoontornkij","doi":"10.1097/PEC.0000000000003332","DOIUrl":"10.1097/PEC.0000000000003332","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to establish and evaluate validity data for pediatric difficult intravenous access (DIVA) scores in low-resource emergency care settings within low- to middle-income countries (LMIC). We also sought to explore associated factors for DIVA that could contribute to a modified pediatric DIVA score with optimal performance in our setting.</p><p><strong>Methods: </strong>We performed a prospective cross-sectional study in children aged 0 to 15 years who required urgent or emergent peripheral intravenous access (PIVA) over a 10-month period in a large university hospital in Bangkok, Thailand. DIVA was defined as a failure of PIVA on the first attempt. For each candidate DIVA model, receiver operating characteristic curves were constructed, and the area under the curves was calculated. Additional candidate predictive factors of patients and providers were collected and analyzed using a logistic regression model.</p><p><strong>Results: </strong>Among a convenience sample of 392 children enrolled, the DIVA rate was 30.1%. Three-variable DIVA (DIVA3) and 4-variable DIVA scores (DIVA4) demonstrated similar test characteristics in our population in identifying patients with first attempt failure rate of at least 50%. Vein visibility, vein palpability, younger age, and history of DIVA were statistically significant factors related to DIVA. Through the inclusion of 4 factors associated with DIVA, the LMIC-DIVA score was developed and exhibited superior discriminative ability compared with the DIVA3 and DIVA4 scores. The area under the curves for LMIC-DIVA, DIVA3, and DIVA4 were 0.79 (95% CI=0.74-0.83), 0.65 (95% CI=0.59-0.70), and 0.62 (95% CI=0.56-0.67), respectively.</p><p><strong>Conclusion: </strong>This study provides external validation data for DIVA3 and DIVA4 scores in the LMIC setting. The novel modified 4-variable LMIC-DIVA score improves test characteristics and accuracy in identifying pediatric DIVA in our population.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"372-377"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"POCUS Standoff: Comparing Ultrasound Interfaces for Soft Tissue Foreign Body Imaging.","authors":"Carolina Vega, Robert Lindsay, Keyon Shokraneh, Celia S Willard, Timothy Gleeson, Monica Kapoor, Ari Nalbandian, Zachary W Binder","doi":"10.1097/PEC.0000000000003359","DOIUrl":"10.1097/PEC.0000000000003359","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound can be used to identify foreign bodies (FBs) in soft tissue. Imaging interfaces such as standoff pads and water baths can improve image resolution for superficial soft tissue structures. Our objective was to determine the optimal interface for FB detection. We hypothesized that water baths would be associated with the greatest FB detection accuracy and image quality.</p><p><strong>Methods: </strong>Prospective analysis of ultrasound imaging interfaces to detect FBs. 18 emergency physicians in training were enrolled: 8 interns, 8 senior residents, and 2 fellows. Four imaging interfaces were compared: gel, saline bag standoff, water bath, and a novel proposed interface: water-filled patient belongings bag (PBB). Standardized FBs (wood, plastic, and metal) were inserted into porcine models, which were imaged by participants using the interfaces. The primary outcome was the accuracy of FB detection for the interfaces. Secondary outcomes included time to FB detection, image quality, and impact of training level. Ultrasounds were reviewed by 2 blinded ultrasound fellowship-trained emergency physicians to determine FB visibility and image quality. Data analysis was performed using the χ 2 test and Kruskal-Wallis test with GraphPad Prism Software.</p><p><strong>Results: </strong>Eighteen participants completed 16 stations. Two hundred eighty-eight ultrasounds total. Interface types demonstrated a trend of greatest accuracy for PBB, followed by water bath, gel, and saline bag. Gel was significantly more accurate than saline bag ( P =0.0120). Gel did not have a significant difference from PBB ( P =0.1425) or water bath ( P =0.125). As training level increased, time to FB detection significantly decreased ( P =0.02), and accuracy increased. Accuracy for fellows was significantly greater than for senior residents ( P =0.0473) and interns ( P =0.0027). There was a trend of greater accuracy in senior residents from interns. However, there was no significant difference ( P =0.0729).</p><p><strong>Conclusions: </strong>PBBs may be a viable alternative interface for soft tissue FB detection. PBBs, water baths, and gel should be considered prior to saline standoffs.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":"354-358"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlates of Suicidal Ideation Among Elementary School-Aged Pediatric Patients.","authors":"Nora Satybaldiyeva, Karen Ferran, Fareed Saleh, Wayne Kepner, Kathryn Hollenbach","doi":"10.1097/PEC.0000000000003401","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003401","url":null,"abstract":"<p><strong>Objectives: </strong>While suicide is the second leading cause of death among 10- to 14-year-old children, information regarding the factors associated with suicide-related behaviors is scarce-especially for children under the age of 12. We aimed to examine characteristics associated with suicidal ideation, as compared with other behavioral health concerns, in elementary school-aged children seeking emergency medical care.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of all 5- to 11-year-old children seen in a pediatric emergency department for a behavioral health concern during a 1-year period. Data on patient demographics, medical history, and behavioral health history were abstracted from the electronic medical record. Multivariate logistic regression was used to determine the associations between demographic and behavioral health characteristics and suicidal ideation.</p><p><strong>Results: </strong>Of the 393 children in the study sample, 56.7% were seen for suicidal ideation, and 43.3% were seen for other behavioral health concerns. Both groups had similar demographic characteristics and were mostly male, White, non-Hispanic, and covered by public health insurance. Patients seen for suicidal ideation were more likely to have depression (adjusted odds ratio (aOR)=2.88, 95% CI: 1.54-5.40), a family history of psychiatric disorders (aOR=2.03, 95% CI: 1.27-3.25), experienced bullying (aOR=2.82, 95% CI: 1.48-5.39), been a victim of abuse (aOR=2.01, 95% CI: 1.10-3.64), and be of older age (aOR=1.33, 95% CI: 1.17-1.52) than patients seen for other behavioral health concerns.</p><p><strong>Conclusions: </strong>Most elementary school-aged children presenting to the emergency department for behavioral health concerns were seen for suicidal ideation. Similar to studies among adolescents, depression, psychiatric family history, bullying, abuse, and age were associated with suicidal ideation among younger children. An important future direction will be to replicate these findings in other geographic locations where children seek emergency medical care for behavioral health conditions and to find ways to address the growing mental health needs of children before they resort to emergency care.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Pediatric Viral Illnesses Before, During, and After the \"Tripledemic\" Viral Surge.","authors":"Jennifer A Jonas, Karen P Acker, Charlene Thomas, Steven Yen, Deborah A Levine","doi":"10.1097/PEC.0000000000003402","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003402","url":null,"abstract":"<p><strong>Objectives: </strong>While children represented a small percentage of those hospitalized during the COVID-19 pandemic, there was a surge of pediatric viral-related admissions in the immediate postpandemic viral season. Our study compares the epidemiology and health care utilization of children with acute respiratory infections during the 2022-2023 season to prepandemic and subsequent postpandemic seasons to see if trends persisted.</p><p><strong>Methods: </strong>We examined administrative data for children who presented to 2 urban pediatric emergency departments (ED) during 3 periods: 2017-2020 (prepandemic), 2022-2023 (immediate postpandemic), and 2023-2024 (subsequent postpandemic). Outcomes included hospitalization rate for viral-related indications, stepdown/intensive care unit (ICU) admission, and use of advanced respiratory support. Multivariable regression controlled for demographics and specific viruses.</p><p><strong>Results: </strong>During the study period, there were 65,313 all-cause ED encounters. Compared with prepandemic seasons, viral-related admissions doubled in 2022-2023. In addition to an increase in ED visits, the odds of viral-related admission increased by 98% [adjusted odds ratio (aOR): 1.98; 99.8% CI: 1.75-2.24], odds of stepdown/ICU admission increased by 131% (aOR: 1.31; 99.8% CI: 1.67-3.21) and odds of advanced respiratory support increased by 70% (aOR: 1.70; 99.8% CI: 1.21-2.40). In 2023-2024, the stepdown/ICU admission rate remained the same compared with 2022-2023, and the odds of advanced respiratory support increased (aOR: 1.79, 99.8% CI: 1.22-2.63). Infection with respiratory syncytial virus increased adjusted odds of more advanced care.</p><p><strong>Conclusions: </strong>Pediatric ED visits and hospitalization rate decreased in 2023-2024 compared with the postpandemic surge, but the admission rate remained high compared with prepandemic seasons, percent admitted to stepdown/ICU persisted, and the use of advanced respiratory support continued to increase.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of an Electronic Universal Mental Health Screening Tool in Pediatric Emergency Departments.","authors":"Sarah McCue Horwitz, Dana E M Seag, Paige E Cervantes, Ruth Gerson, Argelinda Baroni, Fei Guo, Ethan Wiener, Ee Tein Tay, Katherine Ort, Robert D Gibbons","doi":"10.1097/PEC.0000000000003404","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003404","url":null,"abstract":"<p><strong>Objective: </strong>Rates of suicide, anxiety, and depression have soared in US youth, and professional organizations strongly urge earlier identification, particularly in pediatric emergency departments (PEDs). However, there are few commonly used suicide screeners that also identify other mental health (MH) problems. A new, electronically administered instrument, the K-CAT, screens for suicide and multiple MH problems. We hypothesized that the K-CAT would enhance suicide identification compared with routine screening and identify significant anxiety and depression in youth presenting with non-MH chief complaints.</p><p><strong>Methods: </strong>This observational study was conducted in 2 PEDs. Eligible youth were 7 to 17 accompanied by a caregiver without: severe medical concerns, difficult behaviors, limited verbal language, or only a psychiatric complaint. Of the 341 eligible, 241 (70.7%) were screened, and 228 both presented with a non-MH problem and had complete K-CAT data. A Fisher exact test determined whether suicidal behaviors/ideation rates differed between the K-CAT and retrospective chart review data.</p><p><strong>Results: </strong>Seventy-four or 32.46% of youth scored positive for suicide, anxiety, and/or depression on the K-CAT. Females were more likely to screen positive (P<0.001). Compared with the retrospective data, more youth were identified with suicide risk by the K-CAT (3.95% vs. 0%; P=0.004). Youth identified by the K-CAT were 62.5% female and 33.3% 7 to 11 years.</p><p><strong>Conclusions: </strong>The K-CAT increases the identification of suicidal ideation and behaviors overall and in younger children. It identifies significant rates of depression and anxiety in youth and could be an important first step in identifying MH problems in youth.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in Patient Portal Activation and Use in a Pediatric Emergency Department.","authors":"Mary Beth Howard, Keith Kleinman, Philip J Spevak, Muhammad Ismail, Laura M Prichett, Yong Zeng, Leticia M Ryan","doi":"10.1097/PEC.0000000000003398","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003398","url":null,"abstract":"<p><strong>Introduction: </strong>Patient portals enhance patient engagement and health care outcomes, yet their use in pediatric emergency departments (EDs) remains understudied. This study evaluated patient portal activation and proxy use in a pediatric ED, examining associations with demographic and clinical factors.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of electronic health record patient portal use from a single urban pediatric ED from July 1, 2022, to June 30, 2023. Patient portal use was categorized as active, nonactive, and nonuser. We assessed demographic and clinical characteristics associated with portal use and examined proxy use among adolescents.</p><p><strong>Results: </strong>Among 18,964 unique patients (27,454 visits), 58.1% were active portal users, 11.0% were nonactive, and 31.0% were nonusers. Multivariable analyses showed that active users were significantly more likely to be younger [odds ratio (OR): 2.9, 95% CI: 2.6-3.1] and covered by private insurance (OR: 1.6, 95% CI: 1.5-1.7), and less likely to be non-Hispanic black (OR: 0.80, 95% CI: 0.74-0.86). Discharged patients had lower odds of active use (0.51, 95% CI: 0.46-0.56). Among adolescents, patient-only access increased with age, from 1.9% at age 12 to 82.0% at age 17.</p><p><strong>Conclusions: </strong>While overall portal use was high, demographic disparities persist. These findings highlight the need for targeted interventions to enhance equitable portal adoption, ensuring all pediatric ED patients benefit from improved access to their medical records, consistent with the Cures Act Final Rule.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in Pediatric Emergency Department Revisits Within 7 Days by Disease Process.","authors":"Sagar D Mehta, Chris A Rees, Swaminathan Kandaswamy, Andrew Jergel, Scott Gillespie, Jay Shah, Michelle Wallace, Nikolay Braykov, Evan Orenstein, Harold K Simon","doi":"10.1097/PEC.0000000000003388","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003388","url":null,"abstract":"<p><strong>Objective: </strong>To identify disease processes in which patients experienced the greatest rates of emergency department (ED) revisit disparities by race, ethnicity, language, insurance, and Childhood Opportunity Index.</p><p><strong>Methods: </strong>We performed a retrospective, cross-sectional study of ED visits at a comprehensive pediatric health system encompassing three EDs. We included all pediatric (0 to 18 y) ED encounters that led to a discharge home (2018 to 2022). The primary outcome was ED revisit within 7 days of the index encounter. We performed multivariable logistic regression to assess the relationship between diagnoses, patient demographics, and 7-day ED revisit.</p><p><strong>Results: </strong>There were 1,008,651 total ED encounters included [53% (n = 529,960) were male]. Of all encounters, 52,176 (5.2%) had a 7-day ED revisit within the system. Patients who identified as black/African American (adjusted odds ratio [aOR]: 1.14, 95% CI: 1.11-1.17), multiracial (aOR: 1.14, 95% CI: 1.06-1.22), Hispanic (aOR: 1.21, 95% CI: 1.17-1.26), and those with public insurance (aOR: 1.19, 95% CI: 1.16-1.23) had greater odds of ED revisit. Disparities in ED revisits among Hispanic patients were concentrated in a few high-volume diagnoses, particularly within ear, nose, throat (ENT)/dental/mouth diseases (aOR: 1.11, 95% CI: 1.01-1.21) such as upper respiratory infections and infectious ear diseases. Conversely, disparities in ED revisits for black/African American patients were widespread across a broader range of diagnoses.</p><p><strong>Conclusions: </strong>Disease-focused interventions are needed to reduce disparities in ED return visits. Focusing on upstream determinants of health may better reduce the burden of ED revisits for minoritized populations at risk of ED revisits.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using a Clinical Pathway to Safely Reduce Transfers and Admissions for Croup in the Urgent Care.","authors":"Donna R Wyly, Kathleen Berg, Andrea Melanson, Megan Gripka, David Skoglund, Maria V Blanco, Amanda Nedved","doi":"10.1097/PEC.0000000000003396","DOIUrl":"https://doi.org/10.1097/PEC.0000000000003396","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of a croup clinical pathway (CP) on transfer rates from our urgent cares (UCs).</p><p><strong>Methods: </strong>We revised our croup CP in November 2022 to recommend giving additional doses of racemic epinephrine (RE) in UC before transferring a patient and using shared decision-making with families on post-RE observation of their child at home or in a clinical setting. We conducted a retrospective cohort study of patients with croup in 3 UCs who received RE in the pre-CP revision (November 2021 to October 2022) and post-CP revision (November 2022 to October 2023) periods. Interrupted time series analysis evaluated trends over time.</p><p><strong>Results: </strong>We reviewed encounters of 1575 patients diagnosed with croup in the pre-CP revision and 1530 patients in the post-CP revision. In the pre-CP revision period, 77 patients (4.9%) received RE, and 94 patients (6.1%) received RE in the post-CP revision (P=0.09). We saw a decrease in patients who received RE that were transferred from 32.5% in the pre-CP revision period (32.5%) to 10.6% in the post-CP revision period (odds ratio, 0.25; 95% CI, 0.11-0.56; P<0.001). However, Interrupted time series analysis demonstrated downward trends in both time periods with no significant difference over time. Patients discharged within 90 minutes of the last RE increased from 13.5% pre-CP revision to 33.3% post-CP revision (odds ratio, 3.83; 95% CI, 1.46-10.05; P=0.008). We did not see a change in return visits at 24 or 72 hours.</p><p><strong>Conclusion: </strong>Although we saw a downward trend in the percentage of patients with croup transferred after receiving RE in our UCs post-CP revision, we did not see a significant decrease over time. However, this study demonstrates that providing additional RE doses for croup in UC and using shared decision-making with families in the setting for observation did not increase length of stay or return visits.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}