Hospital pediatrics最新文献

{"title":"An Organizational Psychology Approach to Understanding Overuse in Pediatric Hospital Medicine.","authors":"Lyubina Yankova, Monisha Sachdev, Nirali Butala, Alexa Allotta, Rachel Osborn, David Berg, Jaspreet Loyal","doi":"10.1542/hpeds.2025-008340","DOIUrl":"https://doi.org/10.1542/hpeds.2025-008340","url":null,"abstract":"<p><strong>Background: </strong>Medical overuse in pediatrics is estimated to cost $27 million yearly and carries physical and emotional harms. Despite guidelines promoting high-value care, practice has changed minimally, and studies have focused on individual behaviors. We aimed to learn the perspectives of pediatric hospitalists on overuse and apply an organizational psychology framework as a novel way of understanding this issue.</p><p><strong>Methods: </strong>This was a qualitative study interviewing pediatric hospitalists at 2 sites. Interviews were conducted until thematic saturation was reached. Transcripts were coded using grounded-theory methodology and themes were identified. An organizational psychologist reviewed emerging themes and recommended applying the levels of analysis framework, a method for diagnosing institutional issues by examining group and system factors.</p><p><strong>Results: </strong>There were 16 study participants (69% female, 31% male). The following themes influenced physicians toward overuse: (1) at the individual level, fear and risk-aversion, particularly among early-career faculty; (2) at the interpersonal level, the emphasis on maintaining positive interactions and relationships with other clinicians; (3) at the group level, the desire to align with peers; (4) at the intergroup level, using previous interactions with members of a group (such as parents and consultants) to inform the contemporary dynamic; and (5) at the system level, institutional factors and competing priorities, such as patient throughput demands and a focus on errors of omission.</p><p><strong>Conclusions: </strong>Overuse is driven by influence of the individual's membership within a group or system and their interactions with other groups. Interventions should target complex group dynamics and systems pressures contributing to overuse.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555253","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":"Components of Family Meetings for Hospitalized Children With Serious Illness: A Scoping Review.","authors":"Aisling Semple, Melissa Finlay, Asiya Ali, Kate Tsiandoulas, Vishu Chakravarti, Francine Buchanan, Kimberley Widger, Catherine Diskin, Katherine E Nelson","doi":"10.1542/hpeds.2024-008302","DOIUrl":"https://doi.org/10.1542/hpeds.2024-008302","url":null,"abstract":"<p><strong>Context: </strong>Family meetings between pediatric clinicians and parents are used to facilitate in-depth discussions and decision-making about patient care. To guide implementation of family meetings for hospitalized children with medical complexity, this scoping review identified the common components of family meetings for hospitalized pediatric patients with serious illness across pediatric subspecialties.</p><p><strong>Objective: </strong>To describe key components of family meetings for hospitalized pediatric patients with serious illness.</p><p><strong>Data sources: </strong>With the assistance of a professional librarian, we searched 5 databases.</p><p><strong>Study selection: </strong>We included primary research studies describing planned interactions between 2 or more health care providers and family decision-makers for hospitalized children with serious illness.</p><p><strong>Data extraction: </strong>We extracted components of family meetings, which we organized based on timing (before, during, and after the meeting) and combined thematically.</p><p><strong>Results: </strong>We evaluated 11 151 title/abstracts, reviewed 77 full-text articles, and included 23 articles describing 21 studies. Most studies focused on meetings in intensive care units (96%), were conducted in the United States (91%), and were published after 2020 (52%). We identified 15 components occurring before (n = 4), during (n = 8), and after (n = 3) family meetings. Components included both specific tasks (identify need for a meeting) and communication goals (assess and support understanding). Most components were identified through study observations rather than recommendations made by the researchers.</p><p><strong>Conclusion: </strong>There is a developing body of evidence about family meetings, which is largely focused on intensive care settings, that can inform development of targeted research to support implementation of family meetings in pediatric hospital medicine.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545266","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":"Specialty Consultations and Diagnostic Testing Accuracy After Brief Resolved Unexplained Events: A Multicenter Observational Study.","authors":"Nassr Nama, Praveen Jayson Rajasegaran, Lauren M McDaniel, Matthew Donlan, Julie Quet, Jessica L Foulds, Josée Anne Gagnon, Chris Novak, Brigitte Parisien, Ran D Goldman, Anupam Sehgal, Ronik Kanani, Joanna Holland, Amy DeLaroche, Manoj K Mittal, Allayne Stephans, Sanjay Mahant, Eric R Coon, Joel S Tieder, Peter J Gill","doi":"10.1542/hpeds.2024-008305","DOIUrl":"10.1542/hpeds.2024-008305","url":null,"abstract":"<p><strong>Objectives: </strong>Current BRUE guidelines focus on lower-risk infants (approximately 5%), leaving management strategies for the majority undefined. We aimed to evaluate the diagnostic yield and accuracy of tests and subspecialist consultations among all infants with BRUE.</p><p><strong>Methods: </strong>In this retrospective cohort (2017-2021) across 11 Canadian hospitals, we included 1042 infants with BRUE. Records within 90 days of the index visit were reviewed to ascertain diagnostic testing and any newly identified underlying diagnoses. Diagnostic accuracy was evaluated by comparing test results to diagnoses confirmed or considered probable by care teams.</p><p><strong>Results: </strong>Among 855 patients (82.1%) who underwent testing, 72 (8.4%) received explanatory diagnoses, and 554 (64.8%) had nonsignificant or incidental findings. Complete blood count (50.2%, N = 523) had low sensitivity (26.3%) and specificity (57.5%) for anemia and bacterial infections. Electrocardiograms (55.3%, N = 576) showed a sensitivity of 45.5% and specificity of 73.5%, while electroencephalograms (23.3%, N = 243) showed higher sensitivity (72.7%) and specificity (83.3%). Tests like liver enzymes, ammonia, lactic acid, blood cultures, and pertussis testing identified no diagnoses. Four laboratory tests showed a false positive rate (FPR) exceeding 50%: blood gas (57.6%), inborn errors of metabolism testing (51.7%), electrolytes (51.3%), and bilirubin (52.8%). Consultations were provided to 440 patients (42.2%), identifying explanatory diagnoses in 122 (27.7%) and incidental findings in 70 (15.9%).</p><p><strong>Conclusions: </strong>Diagnostic testing and consultations are prevalent but rarely yield significant results, often with high FPR. Consequently, the routine application of these diagnostic approaches should be reconsidered in the absence of targeted clinical indications.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"563-572"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310473","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":"Development of a Modified High-Value Care Rounding Tool.","authors":"William A Frese, Keith Hanson, Yanzhi Wang, Wei-Cheing Hsiao","doi":"10.1542/hpeds.2024-008272","DOIUrl":"10.1542/hpeds.2024-008272","url":null,"abstract":"<p><strong>Background and objectives: </strong>Providers should engage hospitalized patients and families in high-value care (HVC) during rounds. The HVC Rounding Tool (HVC-RT) is the only published tool that assesses providers' HVC rounding performance. However, the HVC-RT has limitations, including little previous quantitative, psychometric assessment of its 3-domain, 10-measure construct. The purpose of this study is to psychometrically evaluate and explore a data-derived, modified HVC-RT structure.</p><p><strong>Methods: </strong>This content validation study conducted a series of psychometric tests on a tertiary center's pediatric hospitalist service's HVC-RT rounding encounter data collected over a 15-month interval: Polychoric correlation first was performed to identify any collinear measures appropriate for elimination in subsequent exploratory factor analysis (EFA). EFA then was applied to generate a data-derived domain and measure arrangement structure. Finally, this new EFA-derived structure was reliability-tested on a domain level using a Kuder-Richardson test (KR-20).</p><p><strong>Results: </strong>A total of 371 encounters were analyzed. Polychoric correlation and EFA together reduced and rearranged the original HVC-RT's 3 domains and 10 measures into a 2-domain, 7-measure construct, comprising a cost-effective care and an individualized hospital care domain. The EFA's Kaiser-Meyer-Olkin measure of sampling adequacy, root mean square residual, measures' factor loading, and communality values, respectively, were 0.8 (values of ≥0.7 preferred), 0.05 (≤0.05 excellent), greater than or equal to 0.6 (≥0.6 strong), and greater than or equal to 0.5 (≥0.4 acceptable). KR-20 results for both EFA domains was adequate at ≥0.6, demonstrating measures' reliability at assessing their respective domains.</p><p><strong>Conclusions: </strong>Psychometric analysis of the original HVC-RT supports its restructure. Our EFA model proposes a shorter, psychometrically derived, modified HVC-RT with acceptable reliability.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e293-e301"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144498273","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":"Association of Care Models and Hospital Reutilization for Children With High-Intensity Neurologic Impairment.","authors":"Margarita Ramos, Margaret Rush, Yuliya Oumarbaeva-Malone, Valerie Jurgens, Bridget Allard, Miriam Bloom, Gabrina Dixon, Matthew Hall, Neha Shah, Priti Bhansali, Kavita Parikh","doi":"10.1542/hpeds.2024-008079","DOIUrl":"10.1542/hpeds.2024-008079","url":null,"abstract":"<p><strong>Background and objectives: </strong>Children with medical complexity (CMC), specifically those with high-intensity neurologic impairment (HINI), account for disproportionate amounts of hospital-based health care. Our objective was to explore the association of CMC-dedicated care models, both presence and composition, with hospital reutilization for children with HINI.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of hospitals in the Pediatric Health Information System and evaluated hospital survey data and reutilization for children with HINI aged 1 to 18 years. Our exposures were CMC-dedicated care model presence and type (inpatient, outpatient, and combined) as determined via survey data from 31 hospitals. Outcomes were any reutilization, including emergency department returns and rehospitalizations within 14 and 30 days of discharge. Generalized estimating equations were used to generate outcomes based on care model presence, adjusting for clinical and demographic factors.</p><p><strong>Results: </strong>In total, 66 560 hospitalizations were included; 82.4% occurred at hospitals with at least 1 CMC-dedicated care model. Compared with discharges from hospitals without any CMC care models, discharged children from hospitals with inpatient-only CMC care models experienced lower odds of any reutilization within 14 days (adjusted odds ratio, 0.69; 95% CI, 0.51-0.94), with a similar association observed at 30 days. This association was not observed for other care model types.</p><p><strong>Conclusion: </strong>Children with HINI are less likely to experience 14- and 30-day health care reutilization when discharged from a hospital that has an inpatient CMC-dedicated care model. Further study is warranted to fully understand the composition of and resources available within CMC-dedicated care models.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"545-553"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303062","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 Medication Safety Review and Adverse Drug Events: A Quality Improvement Study.","authors":"Elizabeth Haines, Rebecca Malizia, Roban Shabbir, Sarah Benton, Katherine Salinas, Alexander F Glick","doi":"10.1542/hpeds.2024-008176","DOIUrl":"10.1542/hpeds.2024-008176","url":null,"abstract":"<p><strong>Objective: </strong>Children are susceptible to adverse drug events, especially those related to high-alert and nephrotoxic medications. This study aimed to reduce the number of days in between reported medication safety events related to high-alert and nephrotoxic medications by 5% over a 28-month period.</p><p><strong>Patients and methods: </strong>This single-center quality improvement study at an urban academic institution occurred across 1 acute care and 3 intensive care units. Interventions focused on increased emphasis on these medications (targeted medication list, rounding script modifications, and provider education), review of medication orders, and rounding audits. Outcomes were the number of days in between events for high-alert and nephrotoxic medications (manual review of events from the event reporting system). Process measures included bundles related to high-alert and nephrotoxic medications (eg, knowledge and discussion of elements) observed during rounds. Metrics were analyzed using statistical process control G charts and run charts.</p><p><strong>Results: </strong>The number of days in between events related to high-alert medications decreased by 10 days; a centerline shift was observed. No centerline shifts were noted for nephrotoxic medications. Special cause variation was noted with more days in between events in the final year of the study period for both high-alert and nephrotoxic medications. Mean process compliance for the high-alert bundle was 90% (monthly range, 67%-100%) and 76% (monthly range, 25%-100%) for the nephrotoxic bundle.</p><p><strong>Conclusions: </strong>Time in between high-alert medication event rates increased; process compliance varied but was unchanged overall. Future work should focus on continued tracking of metrics and incorporating additional interventions, including electronic health record changes.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"573-581"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477065","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":"Hospital Practices and Policies for Neonatal Abstinence Syndrome: United States, 2022.","authors":"Kristin J Marks, Lucas Gosdin, Ellen O Boundy, Erica H Anstey, Jean Y Ko, Jennifer M Nelson","doi":"10.1542/hpeds.2024-008074","DOIUrl":"10.1542/hpeds.2024-008074","url":null,"abstract":"<p><strong>Background and objectives: </strong>Historically, care for newborns with neonatal abstinence syndrome (NAS) focused on pharmacotherapy provided in a neonatal intensive care setting. The understanding of optimal care models is evolving and focuses on nonpharmacologic practices (eg, skin-to-skin/kangaroo care) in settings that minimize overstimulation. We describe the prevalence of nonpharmacologic practices and policies specific to the support of newborns with NAS among US hospitals.</p><p><strong>Methods: </strong>Data from the 2022 Maternity Practices in Infant Nutrition and Care (mPINC) survey were used to determine the prevalence of evidence-based practices and policies related to the management of infants with NAS in US hospitals that provide maternity care. Likert scale response options describing implementation of these practices included few (0%-19%), some (20%-49%), many (50%-79%), or most (≥80%) infants.</p><p><strong>Results: </strong>Three-quarters of hospitals (74.8%) had policies regarding the provision of nonpharmacologic practices for newborns with NAS. About half of hospitals reported that most (≥80%) newborns with NAS experienced skin-to-skin/kangaroo care (52.1%) and rooming-in (50.7%), whereas 34.3% of hospitals reported that most (≥80%) newborns with NAS were breastfed or provided expressed breast milk. Smaller hospitals and hospitals with lower levels of neonatal care more often reported rooming-in for most (≥80%) newborns with NAS.</p><p><strong>Conclusions: </strong>Although 3 in 4 hospitals have policies in place regarding nonpharmacologic care practices, only about half are implementing the practices for most newborns with NAS. Identifying barriers to implementation of nonpharmacologic practices could help efforts to increase these practices when caring for newborns with NAS.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e302-e308"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039958","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":"Evaluation of Shared Decision-Making Interventions in Pediatric Acute Care: A Systematic Review.","authors":"Gemma Postill, Francine Buchanan, Sanjay Mahant, Ahastan Surees, Leo Hersi, Jessie Cunningham, Cornelia M Borkhoff, Nassr Nama, Peter J Gill","doi":"10.1542/hpeds.2024-008220","DOIUrl":"10.1542/hpeds.2024-008220","url":null,"abstract":"<p><strong>Context: </strong>There is limited consensus on the effectiveness of shared decision-making (SDM) interventions in pediatric acute care, where implementing SDM is particularly challenging.</p><p><strong>Objective: </strong>To conduct a systematic review on the effectiveness of SDM interventions in pediatric acute care settings (PROSPERO: CRD42023394760).</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, Cochrane Library, CINAHL, Web of Science, Scopus, and PsycInfo databases from inception to November 12, 2024.</p><p><strong>Study selection: </strong>Studies that evaluated SDM intervention effectiveness for managing acute medical problems-those requiring an urgent or time-sensitive decision at the current clinical visit-in children and youth (aged <19 years).</p><p><strong>Data extraction: </strong>Data were extracted on study participants, study design, clinical decision assessed, and patient-centered and clinical outcomes evaluated.</p><p><strong>Results: </strong>Of 10 278 articles identified, 27 studies were included. These studies focused on acute respiratory infection (n = 5), intensive care unit decision (n = 5), head injury (n = 4), appendicitis (n = 4), febrile infant (n = 3), and other care decisions (n = 6). A breadth of outcome measures and measurement tools were used. In general, SDM interventions had positive impacts on patient-centered and clinical outcomes and were not accompanied by increased resource use, repeat health care utilization, or complications.</p><p><strong>Limitations: </strong>Heterogeneity in SDM interventions and outcome measures limited the ability to conduct meta-analyses on intervention effectiveness.</p><p><strong>Conclusions: </strong>SDM interventions have been evaluated in several pediatric acute care settings. Across a range of studies, SDM interventions were observed to improve patient-centered outcomes without increasing complications. Additional research using standardized outcome measurements is needed.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e326-e342"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267527","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":"A Path Toward Standardized Pediatric Procedural Sedation Education Across Subspecialties.","authors":"Kim Tran Lopez, Ann H Allen, Rebecca K Burger, Corrie Chumpitazi, Courtney M Cox, Abdallah Dalabih, Erin Frank, Jaimee Holbrook, Anna Lin, Snehal P Shah, Jacqueline Walker, Kristin Tiedt","doi":"10.1542/hpeds.2024-008212","DOIUrl":"10.1542/hpeds.2024-008212","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e322-e325"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276212","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":"Systemic Corticosteroids for Acute Viral Bronchiolitis: A Retrospective Multicenter Cohort Study.","authors":"Kayla Delaney, Alexa R Roberts, John M Morrison, Jennifer W Leiding, Anthony A Sochet","doi":"10.1542/hpeds.2024-008221","DOIUrl":"10.1542/hpeds.2024-008221","url":null,"abstract":"<p><strong>Background: </strong>The American Academy of Pediatrics (AAP) 2014 clinical practice guidelines for acute viral bronchiolitis caution against systemic corticosteroid administration. We sought to estimate corticosteroid prescribing rates among critically ill children hospitalized for bronchiolitis and characterize clinical features by corticosteroid prescription.</p><p><strong>Patients and methods: </strong>We performed a retrospective, multicenter cohort study using the Pediatric Hospital Information System database that included children aged 1 to 23 months admitted for acute viral bronchiolitis within 48 pediatric intensive care units from 2013 to 2023. Corticosteroid prescription rates were assessed by year, season, and institution. Patient characteristics, treatments, and clinical outcomes were compared using cohorts defined by corticosteroid prescription.</p><p><strong>Results: </strong>Of 81 376 encounters studied, 30 509 (37.5%) were prescribed corticosteroids. Joinpoint regression of annual prescribing rates yielded a single breakpoint model with prescribing rates decreasing by 2.9% per year before and increasing by 2.1% after 2018. Prescription rates ranged widely by center (17.8%-60.9%). Greater corticosteroid prescription was observed in summer as compared to winter months. Compared to those not prescribed corticosteroids, those prescribed corticosteroids were older (mean age: 10.1 ± 6.3 vs 6.9 ± 5.8 months), had a greater median Pediatric Medical Complexity Algorithm classification (2 [interquartile range, IQR: 1-3] vs 1 [IQR: 1-2]), experienced a longer median length of stay (5 [IQR: 3-10] vs 4 [IQR: 3-6] days), had greater invasive mechanical ventilation rates (33.3% vs 11.8%), and greater albuterol prescription rates (29.6% vs 3.9%; all P < .001).</p><p><strong>Conclusions: </strong>Corticosteroid use among critically ill children with acute viral bronchiolitis remains modest in lieu of AAP recommendations. Prospective research is needed to delineate clinical efficacy for this indication and offer insight for future guidelines.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"590-597"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318232","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}