Hospital pediatrics最新文献

{"title":"DAGs: Directed Acyclic Graphs for Drawing Assumptions and Guiding Causal Inference.","authors":"Evan M Dalton, Andrew S Kern-Goldberger, Michael J Luke, Polina Krass, Christopher P Bonafide","doi":"10.1542/hpeds.2025-008907","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008907","url":null,"abstract":"<p><p>In pediatric hospital medicine, we often rely on observational data to conduct hospital-based research studies. Observational studies may establish a correlation between an exposure and outcome, but for this correlation to be considered causation, researchers must incorporate causal inference methods to control for confounding and reduce study bias. This methodology article reviews the concept of a directed acyclic graph (DAG), which is a causal inference tool that visually depicts the assumed relationships among study variables to guide study design and analytic plans. First, we outline the introductory steps to guide researchers toward building a basic DAG for their research question. Next, we explore the different types of study variables, including mediators, effect modifiers, confounders, and colliders, and clarify the causal assumptions linking them to the exposure and outcome. Finally, we share recommendations for how investigators can incorporate findings from their DAG into their study design and analysis plan. Although DAGs are only as strong as their creator's understanding of the system of interest and its underlying context, we hope to equip readers with the tools necessary to build powerful DAGs that communicate their study assumptions and guide causal inference in research.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Faltering Growth in Infants With Neonatal Opioid Withdrawal Syndrome.","authors":"Polina Frolova Gregory, Joshua Parlaman, Matthew Test, Marshall D Brown, Clara Y Lampi, Shawn Ralston, Corrie E McDaniel","doi":"10.1542/hpeds.2025-008868","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008868","url":null,"abstract":"<p><strong>Objective: </strong>Infants with neonatal opioid withdrawal syndrome (NOWS) often experience excessive weight loss while in the hospital after birth. However, the growth patterns of these infants after hospital discharge are not well understood. We aimed to examine the incidence of faltering growth during the first 4 months of life.</p><p><strong>Methods: </strong>We used electronic health records data to conduct a retrospective matched cohort analysis of infants with and without NOWS born at 2 community hospitals between 2016 and 2019. International Classification of Diseases, Tenth Revision billing codes were used to identify the exposed cohort. Exposed infants with NOWS were matched 1:3 with unexposed infants based on gestational age (+/- 6 days), sex, and birthweight (+/- 100g). Our primary outcome was faltering growth, estimated by logistic regression.</p><p><strong>Results: </strong>We identified 176 exposed and 498 nonexposed infants who met the inclusion criteria. In the exposed cohort, 48% (n = 85) received formula during birth hospitalization, 31% (n = 54) were prescribed increased caloric fortification, and 20% (n = 35) were discharged home on fortified feeds. The average weight loss in exposed infants during birth hospitalization was 7% below birth weight. During the first 4 months of life, 21 out of 176 (12%) infants with NOWS developed faltering growth, with a resulting odds ratio of 1.14 (95% CI 0.65, 1.92) compared with nonexposed infants.</p><p><strong>Conclusion: </strong>We did not observe an increased incidence of faltering growth in infants with NOWS during the first 4 months of life. Additional research is needed to identify which infants with NOWS are at risk for developing faltering growth.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Sedation to Discharge Time for Orthopedic Patients in a Pediatric Emergency Department.","authors":"Jessica Hayes, Tucker Anderson, David Ebenezer, S Barron Frazier","doi":"10.1542/hpeds.2025-008826","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008826","url":null,"abstract":"<p><strong>Background: </strong>Many fractures are reduced in the pediatric emergency department (PED), followed by discharge. We appreciated inefficiencies after sedation. We aimed to decrease the time from sedation end to discharge by 50%, from 240 to 120 minutes, for patients with simple, isolated fractures who undergo fracture reduction in the PED from May 2023 to May 2025.</p><p><strong>Methods: </strong>A multidisciplinary team formed in May 2023. Interventions included the introduction of a portable radiograph order (mini C-arm), a sedation column on the track board, and a policy change to improve flow. The primary outcome was average time from sedation end to discharge. Process measures included percentage of encounters with the mini C-arm ordered and with postreduction films. Secondary outcome measures included average time from sedation end to discharge for patients with and without postreduction films. The balancing measure was the rate of return visits or operating room admissions within 24 hours. Retrospective baseline data were obtained from October 2022 through April 2023. Biweekly data were followed prospectively. Statistical process control charts were used to analyze data.</p><p><strong>Results: </strong>Of 558 total encounters, baseline centerline data represented 68 encounters with an average time from sedation end to discharge of 240 minutes. Interventions led to 3 centerline shifts with a final average time of 71 minutes.</p><p><strong>Conclusions: </strong>This quality-improvement initiative with targeted, interdisciplinary interventions was associated with significantly reduced discharge times after sedation for pediatric fracture reductions. The most impactful was the introduction of mini C-arm imaging for real-time assessment of fracture reductions.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Measure of Relational Outcomes Between Families and Pediatric Complex Care Programs.","authors":"Douglas L Hill, Olivia O Familusi, Karen W Carroll, Priscilla M Ortiz, Annique Hogan, Carolina Rodriguez-Paras, James C Won, Jay G Berry, Ricardo A Mosquera, Chris Feudtner","doi":"10.1542/hpeds.2025-008996","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008996","url":null,"abstract":"<p><strong>Objective: </strong>Complex Care Programs (CCPs) have formed to meet the needs of children with medical complexity (CMC). The effectiveness of CCPs vary for unknown reasons. One explanation for CCP success may involve specific outcomes of the relationships between families of CMC and CCP clinicians. We sought to develop a parent-reported questionnaire, the Relational Outcomes (ReOs) Measure, to assess these relationship outcomes.</p><p><strong>Patients and methods: </strong>The ReOs Measure was designed to capture 5 outcomes of relationships between CCPs and families: Interpersonal trust and respect; Trust regarding shared knowledge and responsibility; Understanding and being understood; Confidence and self-efficacy; and Comprehensive perspective suffused with caring. Parents of children receiving care from the CCP at a children's hospital and health professionals assessed whether the items were clear and whether the measure included all important aspects of their relationship with the CCP.</p><p><strong>Results: </strong>We developed 15 questionnaire items based on prior research and clinical experience and conducted interviews with 14 parents: 9 for the English version and 5 for the Spanish version. Parents reported the items were clear and understandable and were able to give examples for each item from their own experience. Parents affirmed that the items captured important aspects of their relationship with the CCP. Based on parent feedback, 14 items were retained without change, 1 item was revised, and 1 new item was added.</p><p><strong>Conclusions: </strong>The ReOs Measure assesses key outcomes of the relationship between CCPs and families of CMC.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives of PHM Fellowship Graduates Working as Community Hospitalists: A Qualitative Study.","authors":"Rebecca A Ivancie, Vivien K Sun, Ann H Allen, Nehal Thakkar, Jacqueline M Walker","doi":"10.1542/hpeds.2025-008906","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008906","url":null,"abstract":"<p><strong>Objective: </strong>Although many pediatric hospitalists work in community hospitals, little is known regarding fellowship preparation for community pediatric hospital medicine (CPHM) roles, including nonclinical competencies. This study aims to explore fellowship graduates' perspectives on valuable knowledge, skills, and attitudes (KSA) needed in CPHM and to uncover educational gaps in pediatric hospital medicine (PHM) fellowship training.</p><p><strong>Methods: </strong>We conducted 8 online focus groups between October 2023 and August 2024 with recent PHM fellowship graduates who work in CPHM. Study members conducted focus groups using a semistructured interview guide. Demographics were collected by survey and analyzed through descriptive statistics. Two researchers independently coded transcripts and identified domains through content analysis, reconciling differences with a third researcher and reaching consensus with the full team.</p><p><strong>Results: </strong>A total of 20 participants were included in the focus groups. We identified 7 domains relevant to CPHM practice and fellow education: (1) business and leadership, (2) practice in a resource-limited setting, (3) systems-based practice and quality care, (4) interpersonal dynamics, (5) perception of CPHM, (6) career development, and (7) high-stakes clinical competencies.</p><p><strong>Conclusion: </strong>Our findings highlight important KSA necessary for CPHM roles, which are potential educational opportunities during PHM fellowship. For domains already incorporated across fellowship curricula, such as systems-based practice and quality improvement, participants emphasized a need to highlight the CPHM perspective during training. This study suggests an opportunity for PHM fellowship curriculum development to better prepare fellows for careers in CPHM.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Valuing Community Hospital Work in Pediatric Hospital Medicine Fellowships.","authors":"Yevgeniya Harrington, Jessica Myers Allan, Daniel A Rauch","doi":"10.1542/hpeds.2026-009218","DOIUrl":"https://doi.org/10.1542/hpeds.2026-009218","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family-Initiated Interpretation: A New Approach to Communication in the Pediatric ICU.","authors":"Mary Pilarz, Briseyda Morales, Victoria A Rodriguez, Kathryn Jackson, Patrick Murday, Allison P Pack, Marcelo Malakooti, Stacy C Bailey","doi":"10.1542/hpeds.2025-008546","DOIUrl":"10.1542/hpeds.2025-008546","url":null,"abstract":"<p><strong>Background: </strong>Familial use of a language other than English (LOE) is associated with worse outcomes among hospitalized children. Professional interpretation improves outcomes but is underused. This pilot study aimed to evaluate the impact of a family-initiated interpretation intervention on use of interpreters.</p><p><strong>Methods: </strong>We conducted a single-site pilot from April 2023 to January 2024 at a quaternary children's hospital in the midwestern United States. The intervention took place in the pediatric intensive care unit (PICU). Families who used an LOE were encouraged to independently initiate interpretation using hospital-provided tablets. Each patient room had a video interpreter tablet with instructions in the family's primary language. Primary outcomes were the average number and duration of interpreter encounters per patient-day before and after intervention (September 2022-March 2023 vs April 2023-January 2024), analyzed using interrupted time series. Medical team perceptions of intervention feasibility, acceptability, and appropriateness were also measured.</p><p><strong>Results: </strong>There were 158 families in the preintervention group and 271 in the postintervention group. The average duration of interpreter use per patient-day increased from 7.6 to 16.2 minutes (P < .001), and interpreter encounters increased from 0.66 to 1.34 per patient-day (P = .001). Clinician survey responses indicated high acceptability (mean 4.7 ± 0.5), appropriateness (4.7 ± 0.5), and feasibility (4.4 ± 0.7) on a 1 to 5 scale, with 5 indicating \"completely agree,\" with top-box (\"completely agree\") responses on 73%, 74%, and 46% of items, respectively.</p><p><strong>Conclusions: </strong>Family-initiated interpretation was associated with increased interpretation. This strategy may improve interpretation in the PICU.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"454-459"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Much Does It Hurt to Be a Hospitalized Child or Adolescent in a Latin American Country?","authors":"Maria I Cuervo-Suarez, Karen Molina-Gomez, Natalia Duque-Nieto, Catalina Proano Millan, Inés E Gomez, Ximena Garcia-Quintero, Doralina L Anghelescu","doi":"10.1542/hpeds.2024-008171","DOIUrl":"10.1542/hpeds.2024-008171","url":null,"abstract":"<p><strong>Objective: </strong>Adopting an optimized approach to pain assessment and treatment in hospitalized children is crucial. This study aims to explore the prevalence, assessment scales, and treatment of pain in hospitalized children.</p><p><strong>Methods: </strong>We conducted a cross-sectional study (January 2022-January 2023) of pediatric patients (ages 3-17, hospitalized >24 hours). Pain prevalence, intensity, causes, and satisfaction with management were assessed using an 8-item survey complemented by data from electronic health records.</p><p><strong>Results: </strong>The study included 300 children, among whom 247 (82.3%) experienced pain during hospitalization, and 269 (89%) patients reported procedural pain. Eighty-nine (29.7%) patients rated the pain as mild. Patients mainly received nonpharmacological therapy (distraction activities: 239 [79.6%]). One-hundred percent of children with cancer diagnosis (87 patients) reported pain due to procedures compared with patients without cancer (182 [85.8%] of 213 patients) (P < .016). Patients with cancer diagnosis received significantly more occupational therapy (44 [51%]), physical therapy (69 [79%]), psychotherapy (53 [61%]), and opioids (24 [27.6%]) (P < .001) compared with patients not receiving oncological care. Older children received nonpharmacological and pharmacological strategies for pain management more frequently, with significant differences across treatment categories. Two-hundred fifty-one (83.6%) achieved pain relief; severe pain was associated with less relief (17 [74%], P = .029).</p><p><strong>Conclusions: </strong>It hurts to be a hospitalized child or adolescent. In hospitalized children, pain, especially procedural pain, is common; children with cancer experience greater suffering due to this cause. Multimodal strategies improve outcomes for mild/moderate pain. It is important to take an approach that focuses on assessment and comprehensive pain treatment tailored to the needs of the child.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"409-418"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Postedited Artificial Intelligence Translation for Discharge Instructions.","authors":"Ryan C L Brewster, Daniel J Kats, Marwa Elborki, Nymisha Chilukuri, Mondira Ray, Nate Shaar, Jonathan Hron, Alisa Khan","doi":"10.1542/hpeds.2025-008986","DOIUrl":"10.1542/hpeds.2025-008986","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e349-e352"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Introduction to Machine Learning for the Pediatric Hospitalist.","authors":"Austin G Meyer, Stephanie Blasick, Shihao Yang, Mauricio Santillana","doi":"10.1542/hpeds.2025-008939","DOIUrl":"10.1542/hpeds.2025-008939","url":null,"abstract":"<p><p>Machine learning models are increasingly used in clinical research to predict patient outcomes, yet many clinicians lack the training to critically appraise these studies. This article provides a conceptual introduction to machine learning for the pediatric hospitalist with no prior computational experience. We focus on the most common application in clinical medicine: supervised learning, where models learn from data with known outcomes to make predictions about new unseen patients. Core tasks such as classification and regression are explained, along with intuitive models like decision trees and advanced methods like ensembles. Essential concepts for critical appraisal, including overfitting and leakage, the challenge of interpretability, and data bias, are highlighted. We emphasize the importance of model validation and the distinction among prediction, interpretation, and causation. The article concludes by deconstructing a published pediatric study to illustrate these principles in practice, equipping the reader to better understand and evaluate research that uses machine learning. Our goal is to equip pediatric hospitalists with the foundational knowledge to become informed consumers and potential contributors within the machine learning ecosystem, ensuring that this technology augments, rather than replaces, clinical judgment.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e381-e386"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}