Publications by authors named "Andrew Pavia"
We used molecular testing to examine the causes of bloody diarrhea in a multicenter study of pediatric gastroenteritis. Pathogens typically associated with bloody diarrhea were detected in less than half of cases, and inappropriate antibiotic use was common, supporting the use of stool testing in patients with bloody diarrhea.
View Article and Find Full Text PDFArticle Synopsis
- * A study analyzed 5,304 cases of moderate-to-severe diarrhea and identified 2,284 (43%) as severe dehydration using WHO guidelines, but one-third had no attributable pathogens.
- * The most common pathogens varied by age group, with rotavirus being prevalent in younger children, and the findings aim to enhance future prevention and treatment strategies for severe dehydration.
Article Synopsis
- In March 2020, the White House Coronavirus Task Force identified the need for expert treatment guidelines for managing COVID-19 due to its life-threatening nature and lack of known effective treatments.
- The NIH was tasked with quickly assembling a panel of experts to create "living" guidelines, which would be regularly updated as new information about the virus emerged.
- The article reflects on the Panel's experiences over four years, summarizes its final recommendations, discusses ongoing challenges, and notes that the responsibility for COVID-19 guidelines will now shift to professional organizations following the end of the public health emergency.
Article Synopsis
- Viral bronchiolitis is a common illness in kids, and while treatment is mainly supportive, some may have serious bacterial infections (cSBIs) that require antibiotics; identifying these infections can be tricky.
- A study conducted at a children's hospital from 2012 to 2019 looked at children under 2 with bronchiolitis, finding that 4.2% had at least one cSBI, primarily bacterial pneumonia.
- Factors increasing the risk of cSBI included needing invasive mechanical ventilation, high C-reactive protein levels, having complex chronic conditions, and being admitted to the PICU.
Unlabelled: During COVID-19 in the US, social determinants of health (SDH) have driven health disparities. However, the use of SDH in COVID-19 vaccine modeling is unclear. This review aimed to summarize the current landscape of incorporating SDH into COVID-19 vaccine transmission modeling in the US.
View Article and Find Full Text PDFAmong 111 children presenting with bloody diarrhea in a multicenter study of molecular testing in US emergency departments, we found viral pathogens in 18%, bacteria in 48%, protozoa in 2%, and no pathogens detected in 38%.
View Article and Find Full Text PDFAntimicrobial resistance is a global public health crisis. Effective antimicrobial stewardship requires an understanding of the factors and context that contribute to inappropriate use of antimicrobials. The goal of this qualitative systematic review was to synthesize themes across levels of the social ecological framework that drive inappropriate use of antimicrobials in South Asia.
View Article and Find Full Text PDFObjectives: To support a pragmatic, electronic health record (EHR)-based randomized controlled trial, we applied user-centered design (UCD) principles, evidence-based risk communication strategies, and interoperable software architecture to design, test, and deploy a prognostic tool for children in emergency departments (EDs) with pneumonia.
Methods: Risk for severe in-hospital outcomes was estimated using a validated ordinal logistic regression model to classify pneumonia severity. To render the results usable for ED clinicians, we created an integrated SMART on Fast Healthcare Interoperability Resources (FHIR) web application built for interoperable use in two pediatric EDs using different EHR vendors: Epic and Cerner.
Background: Multiplex molecular diagnostic panels have greatly enhanced detection of gastrointestinal pathogens. However, data on the impact of these tests on clinical and patient-centered outcomes are limited.
Methods: We conducted a prospective, multicenter, stepped-wedge trial to determine the impact of multiplex molecular testing at 5 academic children's hospitals on children presenting to the emergency department with acute gastroenteritis.
Antimicrobial resistance is a global public health crisis. Effective antimicrobial stewardship requires an understanding of the factors and context that contribute to inappropriate use of antimicrobials. The goal of this qualitative systematic review was to synthesize themes across levels of the social ecological framework that drive inappropriate use of antimicrobials in South Asia.
View Article and Find Full Text PDFBackground: Meta-analyses have investigated associations between race and ethnicity and COVID-19 outcomes. However, there is uncertainty about these associations' existence, magnitude, and level of evidence. We, therefore, aimed to synthesize, quantify, and grade the strength of evidence of race and ethnicity and COVID-19 outcomes in the US.
View Article and Find Full Text PDFValidation of Childhood Pneumonia Prognostic Models for Use in Emergency Care Settings.
J Pediatric Infect Dis Soc
August 2023
Background: Unwarranted variation in disposition decisions exist among children with pneumonia. We validated three prognostic models for predicting pneumonia severity among children in the emergency department (ED) and hospital.
Methods: We performed a two-center, prospective study of children 6 months to <18 years presenting to the ED with pneumonia from January 2014 to May 2019.
Background: Multiplex molecular diagnostic panels have greatly enhanced detection of gastrointestinal pathogens. However, data on the impact of these tests on clinical and patient-centered outcomes are limited.
Methods: We conducted a prospective, multicenter, stepped-wedge trial to determine the impact of multiplex molecular testing at five academic children's hospitals in children presenting to the ED with acute gastroenteritis.
Background: Shiga toxin-producing E. coli (STEC) infections affect children and adults worldwide, and treatment remain solely supportive. Up to 15-20% of children infected by high-risk STEC (i.
View Article and Find Full Text PDFPersons suffering from acute upper respiratory tract viral infections (URTI) commonly use over the counter (OTC) medicines to relieve symptoms such as fever, muscle aches, cough, runny nose, sore throat and nasal congestion. At present OTC medicines are only licensed for treatment of common cold and flu symptoms and not for treatment of the same symptoms associated with COVID-19. The innate immune response responsible for the mechanisms of the symptoms of URTI is the same for all respiratory viruses including SARS-CoV-2 and these symptoms can be relieved by treatment with the same OTC medicines as available for treatment of colds and flu.
View Article and Find Full Text PDFBackground: Electronic health record-based clinical decision support (CDS) is a promising antibiotic stewardship strategy. Few studies have evaluated the effectiveness of antibiotic CDS in the pediatric emergency department (ED).
Objective: To compare the effectiveness of antibiotic CDS vs.
Objective: To evaluate the association between consolidation on chest radiograph and typical bacterial etiology of childhood community acquired pneumonia (CAP) in the Etiology of Pneumonia in the Community study.
Study Design: Hospitalized children <18 years of age with CAP enrolled in the Etiology of Pneumonia in the Community study at 3 children's hospitals between January 2010 and June 2012 were included. Testing of blood and respiratory specimens used multiple modalities to identify typical and atypical bacterial, or viral infection.
Importance: Inappropriate use of antibiotics for diarrheal illness can result in adverse effects and increase in antimicrobial resistance.
Objective: To determine whether the diarrheal etiology prediction (DEP) algorithm, which uses patient-specific and location-specific features to estimate the probability that diarrhea etiology is exclusively viral, impacts antibiotic prescriptions in patients with acute diarrhea.
Design, Setting, And Participants: A randomized crossover study was conducted to evaluate the DEP incorporated into a smartphone-based electronic clinical decision-support (eCDS) tool.
Background And Objectives: No standardized risk assessment tool exists for community-acquired pneumonia (CAP) in children. This study aims to investigate the association between red blood cell distribution width (RDW) and pediatric CAP.
Methods: Data prospectively collected by the Etiology of Pneumonia in the Community study (2010-2012) was used.
Background: Underlying comorbidities are common in children with pneumonia.
Objective: To determine associations between comorbidity-related functional limitations and risk for severe pneumonia outcomes.
Design, Setting, And Participants: We prospectively enrolled children <18 years with and without comorbidities presenting to the emergency department with clinical and radiographic pneumonia at two institutions.
Objective: To determine whether empirical antibiotic initiation and selection for children with pneumonia was associated with procalcitonin (PCT) levels when results were blinded to clinicians.
Methods: We enrolled children <18 years with radiographically confirmed pneumonia at 2 children's hospitals from 2014 to 2019. Blood for PCT was collected at enrollment (blinded to clinicians).
We aimed to generate an unbiased estimate of the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in 4 urban counties in Utah, USA. We used a multistage sampling design to randomly select community-representative participants >12 years of age. During May 4-June 30, 2020, we collected serum samples and survey responses from 8,108 persons belonging to 5,125 households.
View Article and Find Full Text PDFArticle Synopsis
- The NIH COVID-19 Treatment Guidelines were initiated in March 2020 following a request from the White House Coronavirus Task Force, leading to the establishment of a diverse panel that included experts from multiple sectors to create and update treatment recommendations.
- Within two weeks, the initial guidelines were published online, but the rapid evolution of COVID-19 treatment data necessitated 24 updates in the first year, reflecting the dynamic nature of clinical research.
- Key lessons learned from this process include the importance of accessible, credible guidelines, the value of collaboration among various health entities, the necessity for well-designed clinical trials, and the need for frequent updates to adapt to new evidence.