Hospital pediatrics最新文献

{"title":"Point-of-Care Ultrasound in Pediatric Hospital Medicine: A National Survey.","authors":"Kevin Weinberger, Mary Esther M Rocha, Colleen Keough, Shelley Kumar, Ricardo Quinonez, Erik Su, Adam Cohen","doi":"10.1542/hpeds.2024-008287","DOIUrl":"10.1542/hpeds.2024-008287","url":null,"abstract":"<p><strong>Objective: </strong>To assess the current use, barriers, facilitators, and clinical applications of point-of-care ultrasonography (POCUS) within pediatric hospital medicine (PHM) groups across the United States, aiming to identify opportunities for broader implementation.</p><p><strong>Methods: </strong>Using the Pediatric Research in Inpatient Setting (PRIS) Network, we conducted an anonymous, multicenter, cross-sectional survey targeting PHM groups in both academic children's hospitals and community settings. Descriptive and inferential statistics were used to identify the proportion of PHM divisions using POCUS, the associated characteristics of these groups, their current POCUS applications, and the barriers and facilitators for POCUS implementation.</p><p><strong>Results: </strong>Of the 97 sites surveyed, 56% (n = 54) responded. Of these, 17% (n = 9) reported having a POCUS program. There was no significant difference in POCUS implementation among PHM divisions concerning geographic location, practice setting, number of beds, or faculty. Programs utilizing POCUS identified the following as principle uses: diagnosis of pleural effusions, pneumonia, pericardial effusions, bladder volume, and skin and soft tissue infections and performance of lumbar punctures. Among PHM groups with a POCUS program, 100% had a trained POCUS leader, 78% had dedicated equipment for their division, and 67% had available institutional training for their PHM group. The top barriers identified by PHM groups without a POCUS program included a lack of local POCUS experts, lack of equipment, and cost of equipment.</p><p><strong>Conclusion: </strong>In 2024, more than 1 in 6 PHM divisions responding to this survey actively incorporated POCUS in the care of patients. These applications are diverse and applicable across common inpatient diagnoses.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"686-692"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601831","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":"Risk Factors Associated With Emergency Department Revisits and Subsequent Hospitalizations in Previously Healthy Children Treated for Croup.","authors":"Deanna Hano, Patricia Hametz, Karen Warman","doi":"10.1542/hpeds.2024-008093","DOIUrl":"10.1542/hpeds.2024-008093","url":null,"abstract":"<p><strong>Background and objective: </strong>It is unclear which children are more likely to return to the emergency department (ED) after an ED discharge for croup. We investigated patient-related and care-related factors associated with increased odds of ED revisits and subsequent hospitalizations within 3 days of ED discharge after treatment of croup.</p><p><strong>Methods: </strong>This retrospective multicentered cohort study used the Pediatric Health Information System database. Previously healthy patients aged 6 months to 6 years who presented to pediatric EDs between January 2016 and December 2022 with a primary diagnosis of croup were included. Characteristics of the ED revisit and nonrevisit groups were compared, and multivariable mixed-effects logistic regression analyses were used to evaluate ED revisit within 3 days of discharge and hospital admission after an ED revisit.</p><p><strong>Results: </strong>Of 270 919 unique patients with croup seen and discharged from the ED, 12 470 (4.6%) revisited the ED within 3 days of discharge and 1949 (15.6%) of those who revisited the ED required subsequent hospital admission. Specific patient- and care-related factors were associated with higher odds of ED revisits and need for subsequent admission. Patients who were younger, boys, received racemic epinephrine and/or steroids, received antipyretics or bronchodilators, had chest and/or neck imaging, had electrolyte testing, or presented during the daytime had higher odds of revisiting the ED and requiring subsequent admission.</p><p><strong>Conclusion: </strong>This study suggests consideration of additional risk factors such as age, sex, initial ED treatments, tests, and imaging received when providing appropriate anticipatory guidance and discharge planning for children evaluated in EDs for croup.</p>","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"652-659"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733720","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":"Prevalence of Social Needs Among Hospitalized Children With Complex Chronic Conditions.","authors":"Aditi Vasan, Chén C Kenyon, Chris Feudtner, Alexander G Fiks","doi":"10.1542/hpeds.2024-008317","DOIUrl":"10.1542/hpeds.2024-008317","url":null,"abstract":"","PeriodicalId":38180,"journal":{"name":"Hospital pediatrics","volume":" ","pages":"e318-e321"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}