Hospital pediatrics最新文献

{"title":"Discontinuing Antibiotics for Contaminant Urine Cultures in a Pediatric Emergency Department.","authors":"Yvette L Wang, Begem Lee, Elise Zimmerman, Tatyana G Mills, Amy W Bryl","doi":"10.1542/hpeds.2024-007829","DOIUrl":"https://doi.org/10.1542/hpeds.2024-007829","url":null,"abstract":"<p><strong>Objectives: </strong>In the pediatric emergency department (ED), patients are diagnosed with urinary tract infections (UTIs) and prescribed antibiotics based on urinalysis results while awaiting urine cultures (UCs). If UCs are not consistent with UTIs, antibiotics can be discontinued. Previously, our ED physicians did not contact patients with contaminant UCs, and antibiotics were continued unnecessarily. For patients diagnosed with UTIs but having contaminant UCs, we aimed to increase the percentage of antibiotics discontinued from 3% to 75% in 6 months.</p><p><strong>Methods: </strong>Interventions focused on physician education, physician feedback, and training Resource Nurse Line staff to contact families regarding UCs. Outcome measures were the percentage of patients with contaminant UCs who had antibiotics discontinued and the average antibiotic duration for patients with contaminant UCs. Process measures included the percentage of patients who providers called. Balancing measures included the percentage of patients who had antibiotics discontinued and returned to the ED within 7 days with persistent urinary symptoms. We used statistical process control to examine changes in measures over time.</p><p><strong>Results: </strong>The percentage of patients with antibiotics discontinued increased from 3% to 61% within 10 months, with this change sustained for an additional 12 months. The average antibiotic duration decreased from 7.3 to 4.5 days. The percentage of patients called increased from 5% to 82%. Of the patients who discontinued antibiotics, 1% returned to the ED and were again diagnosed with UTIs.</p><p><strong>Conclusions: </strong>We increased the percentage of patients with contaminant UCs who had antibiotics discontinued and demonstrated sustainability.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812608","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":"Adjunctive Corticosteroids for Acute Bacterial Arthritis? We Still Need More Data.","authors":"Charles R Woods, Laura P Stadler, Sandra R Arnold","doi":"10.1542/hpeds.2024-008282","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008282","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796472","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":"Intravenous Dexamethasone Use and Outcomes in Children Hospitalized With Septic Arthritis.","authors":"Andrew S Kern-Goldberger, Matthew Hall, Marcos Mestre, Jessica L Markham, Marie E Wang, Pratichi K Goenka, Laura H Brower, Alison Payson, Mary Villani, Jaime Rice Denning, Samir S Shah","doi":"10.1542/hpeds.2024-008047","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008047","url":null,"abstract":"<p><strong>Background: </strong>Septic arthritis is routinely treated with joint drainage and antibiotics; however, adjunctive systemic corticosteroids may improve outcomes.</p><p><strong>Objectives: </strong>To (1) describe variation in intravenous dexamethasone use and (2) evaluate the association of intravenous dexamethasone use with outcomes among children hospitalized with septic arthritis.</p><p><strong>Methods: </strong>This is a retrospective cohort study of hospitalized children using the Pediatric Health Information System database. We identified intravenous dexamethasone use (on hospital days 0-2) in children with an International Classification of Diseases, Tenth Revision discharge code for septic arthritis (M00.x). The primary outcome was hospital length of stay (LOS). Secondary outcomes included costs, postdrainage imaging, opioid use, repeat drainage procedures, and 30-day emergency department or hospital revisits. We used propensity score matching to account for measured differences between dexamethasone recipients and nonrecipients.</p><p><strong>Results: </strong>We identified 3524 hospitalizations across 47 hospitals from 2016 to 2020. The median rate of dexamethasone use across hospitals was 28% (IQR, 19%-44%). In the propensity-matched cohort, dexamethasone was associated with shorter LOS (100.5 vs 114.3 hours, P < .001) and lower costs ($16 660 vs $18 243, P = .01) but greater opioid use (odds ratio [OR], 3.80; 95% CI, 1.49-9.70; P < .01). There were no significant differences in 30-day revisits (OR, 0.97; 95% CI, 0.73-1.29; P = .84), postdrainage computed tomography or magnetic resonance imaging (OR, 0.91; 95% CI, 0.71-1.15; P = .42), or repeat drainage procedures (OR, 1.01; 95% CI, 0.81-1.25; P = .94).</p><p><strong>Conclusion: </strong>In this large cohort study, children with septic arthritis receiving dexamethasone had shorter hospital LOS and costs without higher 30-day revisit rates. Dexamethasone use varied widely across hospitals. These findings highlight the need for evaluation in a multicenter randomized trial.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796495","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":"Professional Interpreter Use When a Child is Dying: A Survey of Pediatric Critical Care Clinicians.","authors":"Sean Larsen, Jennifer Needle, Elaine Hsieh, Michael D Evans, Miriam C Shapiro","doi":"10.1542/hpeds.2024-008037","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008037","url":null,"abstract":"<p><strong>Objective: </strong>Approximately 67.8 million people in the United States population speak a language other than English (LOE). Within the health care setting, professional interpreters are critical to providing quality patient care. How pediatric clinicians engage with interpreters is understudied. Our goal was to explore pediatric intensive care unit (PICU)-clinician practices related to interpreter services at time of withdrawal of life-sustaining medical treatment in patients who speak an LOE.</p><p><strong>Methods: </strong>A 44-question web-based survey was distributed via 2 pediatric critical care listservs. Demographics of respondents, types of interpreters available, how interpreters are used, and clinician perception of interpreter services were collected. Comparisons were made using the paired t test.</p><p><strong>Results: </strong>About 176 clinicians completed the survey. Significant differences were seen between in-person and remote interpreters regarding the percentage of clinicians who brief interpreters prior to engaging with the patient/family (84% vs 42%; P < .0001) and confidence in (1) interpretation of their words (72% vs 41%; P < .0001), (2) the communication of the general context of the conversation (89% vs 53%; P < .0001), and (3) in interpreters using their cultural understanding to aid the conversion (79% vs 41%; P < .0001).</p><p><strong>Conclusions: </strong>PICU-clinician engagement and confidence in interpreters was significantly higher for in-person than remote interpreting modalities. We have identified multiple opportunities for improvement in communication between LOE families and clinicians including interpreter briefing, expansion of in-person interpreter availability, and expansion of education on partnering with professional medical interpreters.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781404","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":"MRI Adoption in Pediatric Appendicitis-Trends and Outcomes.","authors":"Courtney W Mangus, Alexander T Janke, Prashant Mahajan, Kenneth A Michelson","doi":"10.1542/hpeds.2024-008077","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008077","url":null,"abstract":"<p><strong>Background and objectives: </strong>Magnetic resonance imaging (MRI) protocols have been implemented to diagnose appendicitis without exposure to ionizing radiation. Our objective was to describe MRI adoption trends and evaluate the association of MRI adoption with appendicitis complications.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of children aged less than 19 years old with appendicitis presenting to 46 pediatric emergency departments between 2010 to 2023. The exposure was presentation at an MRI-adopting hospital, defined as a hospital using MRI more often (> 50%) than computed tomography for patients requiring cross-sectional imaging for appendicitis, determined annually. The primary outcome was complicated appendicitis, based on diagnosis codes for perforation, sepsis, bowel resection, or abscess drainage. Secondary outcomes included intensive care unit admission and hospital length of stay. Logistic regression models with a random intercept for hospital were used to identify the association of MRI adoption and complications.</p><p><strong>Results: </strong>Among 155 884 children with appendicitis, 19 232 presented to MRI-adopting hospitals (12.3%). MRI adoption increased 16.2% per year (95% CI, 8.0-25.0), from 3.0% in 2010 to 18.2% in 2023. MRI adoption was associated with lower odds of any complication (adjusted odds ratio [aOR] 0.79, 95% CI, 0.74-0.84). Appendiceal perforation (aOR 0.77, 95% CI, 0.72-0.82) and abscess drainage (aOR 0.84, 95% CI, 0.73-0.96) occurred less frequently in MRI-adopting hospitals. Intensive care unit admissions were less common at MRI-adopting hospitals (1.1% vs 1.6%; P < .001).</p><p><strong>Conclusions: </strong>Children's hospitals have slowly adopted MRI for appendicitis, but most still primarily rely on computed tomography. Our finding that MRI adoption is associated with a lower risk of complicated appendicitis warrants further investigation.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774424","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":"Loss and Grief in Parents of Children Hospitalized for Congenital Heart Disease.","authors":"Erin Moorman, Conrad Williams, Jennifer Christofferson, Linda G McWhorter, Abigail C Demianczyk, Anne E Kazak, Allison Karpyn, Erica Sood","doi":"10.1542/hpeds.2024-008133","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008133","url":null,"abstract":"<p><strong>Objective: </strong>Nondeath losses and experiences of grief can impact mental health but are understudied among parents of children with complex medical conditions. This study leverages online crowdsourcing, an approach that gathers diverse ideas by soliciting contributions from an online community, to characterize losses experienced by parents of children with congenital heart disease (CHD).</p><p><strong>Methods: </strong>Eighty parents of children with CHD and a prior history of cardiac surgery and hospitalization across 44 US hospitals responded to open-ended questions on a private social networking site as part of a larger study. Data were coded and analyzed using a hybrid inductive-deductive approach, and themes regarding the ways that loss and grief were experienced by parents were identified.</p><p><strong>Results: </strong>Six themes were identified: (1) loss of identity was an overarching theme that cut across the other themes; (2) loss of sense of security/predictability; (3) loss of \"normal/healthy\" pregnancy, birth, and child; (4) work/financial loss; (5) loss of parent-infant bonding and parenting experiences; and (6) loss of/impact on relationships. To support families with their experiences of nondeath losses, parent participants recommended that health care professionals acknowledge and normalize grief, provide memory and meaning-making opportunities, support parents in establishing a bond with their baby, facilitate parent participation in inpatient care, and offer general psychosocial support.</p><p><strong>Conclusions: </strong>Acknowledging and normalizing nondeath losses and grief is paramount to supporting families of children with CHD. A thorough understanding of the types of losses experienced is necessary to better support parents and promote healthy family and child outcomes.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765071","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":"The Effect of a Brief Medical Huddle on Patient and Family Experience During Rounds.","authors":"Rachel Osborn, Henna Boolchandani, Aaron D Bennett, Rebecca Beagan, Lyubina Yankova, Nirali Butala, Heather Collette","doi":"10.1542/hpeds.2024-007998","DOIUrl":"10.1542/hpeds.2024-007998","url":null,"abstract":"<p><strong>Background: </strong>Initial studies of patient- and family-centered rounds (PFCR) in pediatrics used parental interest in participating as the primary outcome. There are mixed results of family satisfaction with the process when compared with standard rounding. To date, there are limited data examining hybrid models of rounding and communication.</p><p><strong>Objective: </strong>We sought to assess the effect of the addition of a standardized interdisciplinary medical huddle before the formal family-centered rounding encounter on patient and family satisfaction with communication and experience on rounds.</p><p><strong>Methods: </strong>Using a quasi-experimental design, we compared family experience for hospitalized children with rounding before and after the introduction of an interdisciplinary medical huddle preceding the PFCR encounter. Family experience was assessed using a 5-question Likert scale survey. The primary outcome measure was self-reported family experience compared between the pre-intervention period (February-June 2017) and postintervention periods (March-July 2021).</p><p><strong>Results: </strong>Mean scores for family experience in the postintervention period were significantly better in \"the doctors used language I could understand\" (3.51 in 2017 compared with 3.71 in 2021; P = .005) and \"the doctors addressed my concerns and questions\" (3.58 in 2017 compared with 3.79 in 2021; P = .009). Overall, the top box response in aggregate was 56% in the pre-intervention period compared with 76% in the postintervention period (P < .001). Rounding time was significantly longer in the postintervention period (17.6 minutes compared with 13.9 minutes; P < .001).</p><p><strong>Conclusions: </strong>Using a prerounds medical huddle in real time was associated with improved family experience on rounds in the general inpatient setting. The development of a shared understanding for all team members, as well as communication planning, likely contributed to these results.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"318-324"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606564","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":"Responding Equitably to Patients and Families in Crisis.","authors":"Susan Wu, Michelle Knutson","doi":"10.1542/hpeds.2024-007775","DOIUrl":"10.1542/hpeds.2024-007775","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e154-e156"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693637","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":"Who Will Take Responsibility?","authors":"Robert M Kliegman","doi":"10.1542/hpeds.2024-007941","DOIUrl":"10.1542/hpeds.2024-007941","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e163-e164"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617528","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":"Sociodemographic Influences on Suicide Risk Screening and Management in Hospitalized Youths.","authors":"Alexandra L Johnson, Kelsey Porada, Sarah H Vepraskas","doi":"10.1542/hpeds.2023-007680","DOIUrl":"10.1542/hpeds.2023-007680","url":null,"abstract":"<p><strong>Background: </strong>Characterizing the relationship between sociodemographic factors and youth suicide risk is crucial for developing prevention strategies and targeted interventions.</p><p><strong>Objective: </strong>We aimed to describe the relationship between hospital-based suicide-risk screening and sociodemographics (race and ethnicity, sex, age, and neighborhood socioeconomic status), discharge disposition, and reuse rates in those with positive screens.</p><p><strong>Methods: </strong>This is a retrospective study of patients aged 10 to 17 years hospitalized between May 2021 and May 2022 at a freestanding children's hospital in Milwaukee, Wisconsin. Screening rates and results were compared across groups using chi-square tests and logistic regression.</p><p><strong>Results: </strong>Five thousand two hundred sixty-one encounters were included, and 83.2% (4375/5261) received suicide-risk screening. Of those screened, 19.3% (843/4375) had positive suicide-risk results. Screening rates were significantly higher among Black or African American patients (P < .001), girls (P = .01), and those aged 13 to 17 years (P < .001). Positive suicide-risk results were most frequent among Hispanic/Latino/Latinx patients (P = .01) and girls (P < .001). Patients aged 10 to 12 years were screened less frequently and had fewer positive suicide-risk results (P < .001). There were no differences based on neighborhood socioeconomic status. Black or African American patients were discharged home more often than white patients (P < .001). Patients with positive suicide-risk screens discharged home had a 6.1% emergency department revisit rate within 7 days of discharge compared with 2.4% of those transferred to inpatient psychiatry (P = .05).</p><p><strong>Conclusion: </strong>We found differences in screening incidence and result (Black or African American and Latinx, sex, and preteens), discharge disposition (Black or African American), and hospital reuse (discharge home) after a positive suicide-risk screen. Our findings call for increased consideration of social determinants when caring for hospitalized youth.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"342-350"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659138","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}