Hospital pediatrics最新文献

{"title":"Adherence With Diagnostic Stewardship Guidance and Sociodemographic Characteristics in the PICU.","authors":"Lauren D Booth, Matthew Linz, Christina Schumacher, Aaron M Milstone, David C Stockwell, Anna C Sick-Samuels","doi":"10.1542/hpeds.2025-008873","DOIUrl":"10.1542/hpeds.2025-008873","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the prevalence of bacterial cultures for patients with new-onset fever or instability obtained that were concordant with a new clinical decision support (CDS) tool within and across sociodemographic characteristics.</p><p><strong>Patients and methods: </strong>A retrospective, cross-sectional evaluation assessing the prevalence of CDS-concordant cultures (blood, urine, respiratory cultures) obtained in an academic pediatric and pediatric cardiac intensive care unit 12 months before and after implementation of the new CDS tool. We compared CDS concordance before and after implementation within sociodemographic subgroups: race, ethnicity, primary language, payor type, biological sex, and age. Next, we compared CDS concordance across sociodemographic categories, before and after the intervention (eg, female vs male), using prevalence ratios (PRs).</p><p><strong>Results: </strong>We analyzed 2838 cultures (1503 pre and 1335 post). There was an improvement in CDS concordance in 13 of the 20 sociodemographic subgroups when comparing the postintervention with the preintervention period. Comparing across sociodemographic categories, there were no differences in CDS-concordant testing prevalence across race, ethnicity, primary language, or sex. However, we identified differences in CDS concordance by age. Before the intervention, cultures in patients younger than 6 months had 18% lower CDS concordance than patients older than 15 years (reference group) (PR 0.82, 95% CI 0.69-0.98); there was no difference after the intervention. Similarly, cultures in patients aged between >5 and 15 years had 23% lower CDS concordance than patients older than 15 years (PR 0.77, 95% CI 0.63-0.96); this attenuated after the intervention (PR 0.86, 95% CI 0.74-0.99).</p><p><strong>Conclusions: </strong>A new CDS tool was associated with an increase in CDS-concordant bacterial culture practices within most sociodemographic subgroups and enhanced culture ordering practices among younger patients.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"427-434"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730341","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":"Trends in Pediatric Imaging From 1997 to 2024 in an Integrated Health Care Setting.","authors":"Malini Mahendra, Taewoon Kang, Jeannette Ferber, Hana Azman Firdaus, Carly Stewart, Aubrey Roland, De-Kun Li, Marilyn L Kwan, Diana L Miglioretti, Rebecca Smith-Bindman","doi":"10.1542/hpeds.2025-009046","DOIUrl":"10.1542/hpeds.2025-009046","url":null,"abstract":"<p><strong>Objective: </strong>Characterize cross-sectional imaging (magnetic resonance imaging [MRI], computed tomography [CT], ultrasonography [US]) use in children between 1997 and 2024.</p><p><strong>Methods: </strong>Retrospective cross-sectional study of cross-sectional imaging from Kaiser Permanente Northern. Cross-sectional imaging rates per 1000 children by modality, age, and body region were computed. Joinpoint regression was used to analyze trends in cross-sectional imaging use.</p><p><strong>Results: </strong>In total, 1 237 794 cross-sectional imaging examinations were performed in 18 132 171 children. From 2017 to 2024, cross-sectional imaging increased 50% (relative rate 1.46 [95% CI, 1.45-1.48]) from 79 (95% CI, 79-79) to 116 (95% CI, 115-117) examinations/1000 children associated with an average annual increase of 6.3% (95% CI, 5.0%-6.5%). Average annual MRI growth 2017 to 2024 was 6.7% (95% CI, 6.1%-7.3%); MRI use reached its peak rate in 2024: 41 (95% CI, 40-41) examinations/1000 children. CT use increased prior to 2009 (average annual change 7.6% [95% CI, 5.9%-9.2%]), decreased between 2009 and 2016 (average annual change: -2.9% [95% CI, -4.7% to -1.0%]), and then increased from 2017 to 2024 (average annual change: 7.3% [95% CI, 4.1%-11%]), reaching a peak rate of 26 (95% CI, 26-26) examinations/1000 children in 2024. Average annual change in US use 2017-2024 was 3.0% (95% CI, -0.3% to 6.4%), reaching its peak use rate in 2024 of 49 (95% CI, 49-49) examinations/1000 children. An estimated 8,880 future cancers in 2017 and 15,420 in 2024 in the United States may be attributable to CT use observed in this cohort.</p><p><strong>Conclusion: </strong>Cross-sectional imaging use in children significantly increased over time, reaching its highest use in 2024. CT imaging grew markedly, reversing a previous trend of decreasing CT use. Additional research is needed to identify factors driving increased imaging use.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"366-375"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784148","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":"Launching the Health Equity Academic Research in Pediatric Hospital Medicine (HEAR-PHM) Program.","authors":"Amina Touma, Kavita Parikh, Gabrina Dixon","doi":"10.1542/hpeds.2025-008477","DOIUrl":"10.1542/hpeds.2025-008477","url":null,"abstract":"<p><strong>Background: </strong>As a young and rapidly evolving subspecialty, pediatric hospital medicine (PHM) has an opportunity to develop programs to promote health equity and become a leader in health equity research for the acute-care setting. Our innovative research education program, Health Equity Academic Research in Pediatric Hospital Medicine (HEAR-PHM), is a vehicle for this development. This report will describe the HEAR-PHM program and the scholarship interests of the program scholars.</p><p><strong>Methods: </strong>The HEAR-PHM program uses a cohort-based approach and has 3 core components: (1) didactic, small group learning with health equity experts; (2) hands-on capstone research project with peer and faculty support; and (3) peer networking and community building to foster health equity researchers within PHM. We developed and distributed a Scholarship Needs Assessment using the National Institute on Minority Health and Health Disparities (NIMHD) framework and analyzed data using descriptive statistics.</p><p><strong>Results: </strong>The HEAR-PHM inaugural cohort launched in September 2024 with 14 scholars from 11 academic institutions around the country. The Scholarship Needs Assessment had a 92.85% completion rate (n = 13) with responses from 5 pediatric hospital medicine fellows (38.5%), 1 clinical instructor (7.7%), and 7 assistant professors (53.8%). Using NIMHD framework, scholars showed a strong interest in the sociocultural environment and health care system domains of influence, specifically focusing on the community and interpersonal levels of influence.</p><p><strong>Conclusions: </strong>As a growing pediatric specialty, understanding the areas of health equity scholarship within the PHM community may help us develop innovative collaboratives, networks, and partnerships to advance health equity work to improve health outcomes.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e323-e327"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634329","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":"Toward a Community Standard for Clinical Ethics: The South Florida Pediatric Bioethics Consortium.","authors":"Amanda Alladin, Kenneth W Goodman, Eileen Johnson, Hugh J Ladd, Jacqueline Machado, Ronald Ford, Jeffrey P Brosco","doi":"10.1542/hpeds.2025-008643","DOIUrl":"10.1542/hpeds.2025-008643","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e362-e364"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640068","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 Between Health-Related Social Needs and Pediatric Hospitalization Outcomes.","authors":"Hemen Muleta, Samantha Levano, Jonathan M Gabbay, Miya Lemberg, Florinda Islamovic, Patricia Hametz, Gina Cassel-Choudhury, Henry M Ushay, Michael L Rinke, Shivani Agarwal, Kevin P Fiori","doi":"10.1542/hpeds.2025-008800","DOIUrl":"10.1542/hpeds.2025-008800","url":null,"abstract":"<p><strong>Background and objectives: </strong>Health-related social needs (HRSNs) are linked to worse health outcomes and increased low-value acute care use. HRSN impact on hospital length of stay (LOS) and other inpatient metrics remain underexplored. We aimed to evaluate the association between HRSNs and adverse health care utilization outcomes. Our primary outcome was LOS. Secondary outcomes included pediatric intensive care unit (PICU) admission, 30-day readmission, and 30-day emergency department (ED) revisit.</p><p><strong>Methods: </strong>This is a retrospective cohort study of hospitalized pediatric patients screened for HRSNs between November 1, 2023, and October 31, 2024. Multivariable mixed-effects regression was used to assess the association between outcomes and having 1 or more HRSNs. Models were adjusted for sociodemographic characteristics, presence of medical complexity, admission month, and exposure to community health workers. An exploratory analysis assessed interactions between medical complexity and HRSNs on LOS.</p><p><strong>Results: </strong>Among 3645 encounters, 1049 (28.8%) reported at least 1 HRSN. In adjusted models, having 1 or more HRSNs was associated with a 0.45-days-longer LOS (95% CI, 0.23-0.67) and 38% higher odds of PICU admission (adjusted odds ratio, 1.38; 95% CI, 1.02-1.86). There were no significant associations with 30-day readmission or ED revisit. Patients with both 1 or more HRSNs and medical complexity had an estimated 3.13-days-longer LOS (95% CI, 2.48-3.78) than those with neither.</p><p><strong>Conclusions: </strong>Unmet HRSNs are associated with longer LOS and greater likelihood of PICU admission. Children with medical complexity who have unmet social needs may particularly benefit from targeted social care interventions. Future work should assess the impact of such interventions on key hospitalization measures.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"384-392"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692661","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":"Lost in Translation? Impact of Patient Language on Wait Times in a Pediatric Emergency Department.","authors":"Taylor Anderson, Donald H Arnold, Adriana Bialostozky, Jillian M Berkman, S Barron Frazier","doi":"10.1542/hpeds.2025-008739","DOIUrl":"10.1542/hpeds.2025-008739","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between patients' preferred language and wait times in the pediatric emergency department (PED), hypothesizing that patients preferring languages other than English (LOE) wait longer to see a provider.</p><p><strong>Patients and methods: </strong>We conducted a retrospective analysis of patients arriving at a PED between January 2022 and December 2023. Patient demographic and wait time data were obtained from the electronic health record. Bivariate and multivariable regression analyses examined the relationship between wait times and covariates, including preferred language, race and ethnicity, primary insurance, and illness acuity.</p><p><strong>Results: </strong>A total of 96 273 patients and 90 544 patients were included in bivariate and multivariable analyses, respectively. Bivariate analyses showed wait time differences from rooming to provider evaluation for language and race and ethnicity (P < .05). Multivariable linear regression analyses showed patients preferring LOE waited an adjusted 1.1 minutes longer for triage (95% CI, 0.7-1.4), 5.5 minutes longer for rooming (95% CI, 4.4-6.6), and 3.8 minutes longer for provider evaluation after rooming (95% CI, 3.4-4.2) compared with patients preferring English. Non-white patients and patients preferring LOE had shorter times to disposition, 4.1 minutes (95% CI, 1.5-6.8) and 7.2 minutes (95% CI 5.1-9.2) faster, and lower odds of hospital admission, adjusted odds ratios of 0.71 (95% CI, 0.69-0.74) and 0.74 (95% CI, 0.7-0.78), respectively.</p><p><strong>Conclusions: </strong>Patients preferring LOE experienced longer wait times for provider evaluation but shorter times to disposition after initial assessment and lower adjusted odds of hospital admission. Non-white patients experienced lower adjusted hospital admission odds, raising concerns about differences in clinical decision-making based on demographic characteristics.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"393-399"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595360","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":"Conceptualizing Post-Intensive Care Syndrome: A Qualitative Exploration of the Family Experience.","authors":"Annie Laurie Gula, Dorene F Balmer, Douglas L Hill, May Shum, Wynne Morrison, Neethi Pinto","doi":"10.1542/hpeds.2025-008621","DOIUrl":"10.1542/hpeds.2025-008621","url":null,"abstract":"<p><strong>Background: </strong>After a pediatric intensive care unit (PICU) admission, children can experience long-term effects on their growth and development, termed post-intensive care syndrome in pediatrics (PICS-p). The impact of a PICU admission on a family's social health is understudied, especially for families with low socioeconomic status (SES) who may be at greater risk for PICS-p. This study explored how families with low SES experience the social aftermath of a PICU admission, specifically the impacts on aspects of social health, including routines, relationships, and finances.</p><p><strong>Methods: </strong>We performed a prospective cohort study using a constructivist approach to qualitative research. We purposefully sampled and interviewed primary caregivers of patients with low SES requiring PICU admission 1 to 2 months after hospital discharge. Consistent with reflexive thematic analysis, we created inductive codes, developed themes from these codes, and used an existing family adaptation model to organize themes.</p><p><strong>Results: </strong>We interviewed 20 families (17 mothers, 1 foster mother, 1 grandmother, and 1 father) and constructed the following themes: (1) families had to adjust to achieve a balance, even before the PICU admission; (2) a PICU admission is a critical disruption; and (3) families had to actively work to adapt after PICU admission by increasing supports, decreasing demands, and altering their attitudes.</p><p><strong>Conclusions: </strong>PICU admission can be a critical disruption requiring families to adapt to a new normal. Building on existing literature, we present the Family Adjustment and Adaptation to Critical Illness model. Future efforts should work to understand and optimize families' ability to increase supports and decrease demands.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"400-408"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609135","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":"Discrimination in Health Care Against Children With Medical Complexity and Caregiver Mental Health.","authors":"Stefanie G Ames, Elizabeth Patterson, George Verdelis, Christina K Zigler, Danielle M Gerber, Amy J Houtrow, Amanda K Gatewood, S Margaret Wright, Huong D Meeks, Ryan J Coller","doi":"10.1542/hpeds.2025-008876","DOIUrl":"10.1542/hpeds.2025-008876","url":null,"abstract":"<p><strong>Background and objectives: </strong>Discrimination in health care settings negatively impacts adult health and well-being; however, it is not well studied in pediatrics. This study aimed to evaluate discrimination in medical settings in a multi-site cohort and examine its association with caregiver mental health.</p><p><strong>Methods: </strong>This cross-sectional study used survey responses from 718 caregiver-child dyads from 9 academic medical centers participating in the Family CIRCLE cohort. Eligibility criteria included age younger than 16 years and at least 1 complex chronic condition and at least 2 health care encounters in the prior year. The primary exposure was the Discrimination in Medical Settings (DMS) Scale adapted for child health with higher scores indicating more discrimination. The primary outcome was self-perceived caregiver mental health. Responses were dichotomized into favorable (excellent, very good, good) and unfavorable (fair, poor) categories. Multivariate logistic regression models estimated the association between DMS responses and unfavorable mental health.</p><p><strong>Results: </strong>Of 673 caregivers who completed at least 1 DMS question, 401 (59.6%) reported experiencing some discrimination. The median (IQR) discrimination score was 9 (7-14, range: 7-28). Compared with caregivers of children without a disability, caregivers of children with disabilities reported more discrimination (P < .001). In a multivariable model adjusting for child and caregiver characteristics, DMS scores in the highest quartile (vs the lowest) had higher odds of unfavorable caregiver mental health (adjusted odds ratio: 2.5 [95% CI: 1.5-4.1]).</p><p><strong>Conclusions: </strong>Discrimination in medical settings was reported by 60% of caregivers of children with medical complexity and was associated with increased odds of unfavorable caregiver mental health. Future efforts should address discrimination to improve health systems.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"435-445"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677482","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":"Diagnostic Accuracy of Risk-Stratification Strategies for Premature Febrile Infants 8-60 Days Old.","authors":"Alexandra Itzkovitz, Alexandra Yannopoulos, Kelley-Anne Dionne, Brett Burstein","doi":"10.1542/hpeds.2025-009119","DOIUrl":"10.1542/hpeds.2025-009119","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e346-e348"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724155","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":"Labetalol Cross-Reactivity With Fentanyl in Universal Intrapartum Screening.","authors":"Maheen Farooq, Jonathan Blau, Un Jung Lee, Priyadarshani Giri, Philip Roth","doi":"10.1542/hpeds.2025-008829","DOIUrl":"10.1542/hpeds.2025-008829","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e353-e355"},"PeriodicalIF":2.1,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784058","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}