Publications by authors named "Hanieh Razzaghi"

Article Synopsis
  • * Conducted across 26 children's hospitals in the US from March 2020 to May 2023, the research involved analyzing data from over 172,000 eligible children and young adults aged 5 to 20 with confirmed COVID-19.
  • * The findings aim to establish a clear association between pre-infection BMI categories—ranging from healthy weight to severe obesity—and the likelihood of experiencing PASC, with statistical analyses adjusting for various demographic and clinical
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Pediatric Long COVID has been associated with a wide variety of symptoms, conditions, and organ systems, but distinct clinical presentations, or subphenotypes, are still being elucidated. In this exploratory analysis, we identified a cohort of pediatric (age <21) patients with evidence of Long COVID and no pre-existing complex chronic conditions using electronic health record data from 38 institutions and used an unsupervised machine learning-based approach to identify subphenotypes. Our method, an extension of the Phe2Vec algorithm, uses tens of thousands of clinical concepts from multiple domains to represent patients' clinical histories to then identify groups of patients with similar presentations.

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Article Synopsis
  • - The study emphasizes the importance of thorough data quality testing to reduce analytic errors in observational research using clinical data, specifically focusing on the PRESERVE study about chronic kidney disease in children.
  • - A systematic approach was utilized for data quality assessments, consisting of two evaluation rounds that uncovered numerous data quality issues—115 in the first round and 157 in the second—related to completeness, consistency, and data model adherence.
  • - By prioritizing the resolution of critical data quality problems, the research team improved data accuracy and avoided excluding institutions from the study, ultimately enhancing the reliability of the analysis outcomes.
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Article Synopsis
  • The study assesses a new algorithm for identifying Long COVID in pediatric patients, aiming to standardize how this condition is defined and recognized in the medical community.
  • Using data from 31,781 patients, the algorithm showed moderate accuracy when compared to traditional chart reviews, with an overlap rate of 62%, but also noted significant disagreement on cases.
  • The findings suggest that discrepancies may stem from varying interpretations of Long COVID symptoms, emphasizing the need for a clearer clinical definition to improve identification and support research efforts.
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Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe post-acute sequela of SARS-CoV-2 infection. The highly diverse clinical features of MIS-C necessities characterizing its features by subphenotypes for improved recognition and treatment. However, jointly identifying subphenotypes in multi-site settings can be challenging.

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Objectives: Vaccination reduces the risk of acute coronavirus disease 2019 (COVID-19) in children, but it is less clear whether it protects against long COVID. We estimated vaccine effectiveness (VE) against long COVID in children aged 5 to 17 years.

Methods: This retrospective cohort study used data from 17 health systems in the RECOVER PCORnet electronic health record program for visits after vaccine availability.

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Article Synopsis
  • The study evaluates the BNT162b2 vaccine's effectiveness in preventing COVID-19 infection and severe illness in children and adolescents, focusing on the Delta and Omicron variants.
  • It involved analyzing data from over 77,000 adolescents during the Delta phase and 167,000 children and adolescents during the Omicron phase, comparing vaccinated individuals to those unvaccinated.
  • Results showed the vaccine was extremely effective (98.4%) during the Delta period, while the effectiveness during the Omicron period dropped to around 74.3%, with no significant impact on cardiac complications among vaccinated individuals.
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Multi-system inflammatory syndrome in children (MIS-C) is a severe post-acute sequela of SARS-CoV-2 infection in children, and there is a critical need to unfold its highly heterogeneous disease patterns. Our objective was to characterize the illness spectrum of MIS-C for improved recognition and management. We conducted a retrospective cohort study using data from March 1, 2020-September 30, 2022, in 8 pediatric medical centers from PEDSnet.

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Article Synopsis
  • The BNT162b2 vaccine was effective in preventing COVID-19 infection among adolescents during the Delta variant period, showing a 98.4% effectiveness without significant waning after the first dose.
  • During the Omicron period, the vaccine's effectiveness decreased to 74.3% against infections in children, while still providing strong protection against severe disease and ICU admissions.
  • The study involved a large sample size across different age groups and carefully assessed potential risks related to vaccination, especially concerning cardiac complications, and found no increased risk.
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Rationale & Objective: PRESERVE seeks to provide new knowledge to inform shared decision-making regarding blood pressure (BP) management for pediatric chronic kidney disease (CKD). PRESERVE will compare the effectiveness of alternative strategies for monitoring and treating hypertension on preserving kidney function; expand the National Patient-Centered Clinical Research Network (PCORnet) common data model by adding pediatric- and kidney-specific variables and linking electronic health record data to other kidney disease databases; and assess the lived experiences of patients related to BP management.

Study Design: Multicenter retrospective cohort study (clinical outcomes) and cross-sectional study (patient-reported outcomes [PROs]).

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Objective: Vaccination reduces the risk of acute COVID-19 in children, but it is less clear whether it protects against long COVID. We estimated vaccine effectiveness (VE) against long COVID in children aged 5-17 years.

Methods: This retrospective cohort study used data from 17 health systems in the RECOVER PCORnet electronic health record (EHR) Program for visits between vaccine availability, and October 29, 2022.

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As clinical understanding of pediatric Post-Acute Sequelae of SARS CoV-2 (PASC) develops, and hence the clinical definition evolves, it is desirable to have a method to reliably identify patients who are likely to have post-acute sequelae of SARS CoV-2 (PASC) in health systems data. In this study, we developed and validated a machine learning algorithm to classify which patients have PASC (distinguishing between Multisystem Inflammatory Syndrome in Children (MIS-C) and non-MIS-C variants) from a cohort of patients with positive SARS- CoV-2 test results in pediatric health systems within the PEDSnet EHR network. Patient features included in the model were selected from conditions, procedures, performance of diagnostic testing, and medications using a tree-based scan statistic approach.

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The rarity of primary hyperoxaluria (PH) challenges our understanding of the disease. The purpose of our study was to describe the course of clinical care in a United States cohort of PH pediatric patients, highlighting health service utilization. We performed a retrospective cohort study of PH patients < 18 years old in the PEDSnet clinical research network from 2009 to 2021.

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Background: IgA vasculitis is the most common vasculitis in children and is often complicated by acute nephritis (IgAVN). Risk of chronic kidney disease (CKD) among children with IgAVN remains unknown. This study aimed to describe the clinical management and kidney outcomes in a large cohort of children with IgAVN.

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Article Synopsis
  • - The study investigates whether obstructive sleep apnea (OSA) increases the risk of Post-Acute Sequelae of SARS-CoV-2 (PASC) in COVID-19 patients, utilizing data from multiple health research networks.
  • - Researchers calculated odds ratios to compare the likelihood of developing PASC in those with and without a prior OSA diagnosis, with results showing that adults with OSA exhibited a significantly higher risk.
  • - The findings indicate that adults with preexisting OSA may be at greater risk for long-term complications following COVID-19, suggesting the need for closer monitoring of these patients post-infection.
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Objectives: Post-acute sequalae of SARS-CoV-2 infection (PASC) is not well defined in pediatrics given its heterogeneity of presentation and severity in this population. The aim of this study is to use novel methods that rely on data mining approaches rather than clinical experience to detect conditions and symptoms associated with pediatric PASC.

Materials And Methods: We used a propensity-matched cohort design comparing children identified using the new PASC ICD10CM diagnosis code (U09.

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Using an electronic health record-based algorithm, we identified children with Coronavirus disease 2019 (COVID-19) based exclusively on serologic testing between March 2020 and April 2022. Compared with the 131 537 polymerase chain reaction-positive children, the 2714 serology-positive children were more likely to be inpatients (24% vs 2%), to have a chronic condition (37% vs 24%), and to have a diagnosis of multisystem inflammatory syndrome in children (23% vs <1%). Identification of children who could have been asymptomatic or paucisymptomatic and not tested is critical to define the burden of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 infection in children.

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Article Synopsis
  • Researchers studied electronic health records and chart reviews from nine pediatric medical centers to find seven children diagnosed with MIS-C who were treated as outpatients.* -
  • The study highlights that some cases of MIS-C can have mild symptoms and do not necessarily require hospitalization.* -
  • The findings aim to increase awareness among healthcare providers about the possibility of managing MIS-C outpatient instead of automatically admitting children to the hospital.*
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Background: As clinical understanding of pediatric Post-Acute Sequelae of SARS CoV-2 (PASC) develops, and hence the clinical definition evolves, it is desirable to have a method to reliably identify patients who are likely to have post-acute sequelae of SARS CoV-2 (PASC) in health systems data.

Methods And Findings: In this study, we developed and validated a machine learning algorithm to classify which patients have PASC (distinguishing between Multisystem Inflammatory Syndrome in Children (MIS-C) and non-MIS-C variants) from a cohort of patients with positive SARS-CoV-2 test results in pediatric health systems within the PEDSnet EHR network. Patient features included in the model were selected from conditions, procedures, performance of diagnostic testing, and medications using a tree-based scan statistic approach.

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Background: Multi-system inflammatory syndrome in children (MIS-C) represents one of the most severe post-acute sequelae of SARS-CoV-2 infection in children, and there is a critical need to characterize its disease patterns for improved recognition and management. Our objective was to characterize subphenotypes of MIS-C based on presentation, demographics and laboratory parameters.

Methods: We conducted a retrospective cohort study of children with MIS-C from March 1, 2020 - April 30, 2022 and cared for in 8 pediatric medical centers that participate in PEDSnet.

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Background: Children with glomerular disease have unique risk factors for compromised bone health. Studies addressing skeletal complications in this population are lacking.

Methods: This retrospective cohort study utilized data from PEDSnet, a national network of pediatric health systems with standardized electronic health record data for more than 6.

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Introduction: Efficient methods to obtain and benchmark national data are needed to improve comparative quality assessment for children with type 1 diabetes (T1D). PCORnet is a network of clinical data research networks whose infrastructure includes standardization to a Common Data Model (CDM) incorporating electronic health record (EHR)-derived data across multiple clinical institutions. The study aimed to determine the feasibility of the automated use of EHR data to assess comparative quality for T1D.

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Importance: The postacute sequelae of SARS-CoV-2 infection (PASC) has emerged as a long-term complication in adults, but current understanding of the clinical presentation of PASC in children is limited.

Objective: To identify diagnosed symptoms, diagnosed health conditions, and medications associated with PASC in children.

Design, Setting And Participants: This retrospective cohort study used electronic health records from 9 US children's hospitals for individuals younger than 21 years who underwent antigen or reverse transcriptase-polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 between March 1, 2020, and October 31, 2021, and had at least 1 encounter in the 3 years before testing.

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Purpose: We evaluated the utility of diagnostic codes to screen for patients with primary hyperoxaluria (PH) and evaluate their positive predictive value (PPV) in identifying children with this rare condition in PEDSnet, a clinical research network of pediatric health systems that shares electronic health records data.

Materials And Methods: We conducted a cross-sectional study of children who received care at 7 PEDSnet institutions from January 2009 through January 2021. We developed and applied screening criteria using diagnostic codes that generated 3 categories of the hypothesized probability of PH.

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Objective: To identify associations between weight status and clinical outcomes in children with lower respiratory tract infection (LRTI) or asthma requiring hospitalization.

Methods: We performed a retrospective cohort study of 2 to 17 year old children hospitalized for LRTI and/or asthma from 2009 to 2019 using electronic health record data from the PEDSnet clinical research network. Children <2 years, those with medical complexity, and those without a calculable BMI were excluded.

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