Factors Associated With Prolonged Mental Health Admissions at US Children's Hospitals.

Background And Objectives: Mental health (MH) hospitalizations at medical hospitals are associated with longer length of stay (LOS) compared with non-MH hospitalizations, but patient factors and costs associated with prolonged MH hospitalizations are unknown. The objective of this paper is to assess patient clinical and demographic factors associated with prolonged MH hospitalizations and describe variation in MH LOS across US children's hospitals.

Methods: We studied children aged 5 to 20 years hospitalized with a primary MH diagnosis during 2021 and 2022 across 46 children's hospitals using the Pediatric Health Information System database.

Spending on public benefit programs and exposure to adverse childhood experiences.

Background: Adverse childhood experiences are associated with poverty, and public benefit programs are increasingly used as primary prevention for negative child outcomes.

Objective: To estimate the association between spending on benefit programs and cumulative exposure to ACEs among children.

Participants And Setting: Children aged 0-17 years in the United States during 2016-17 as reported in National Survey of Children's Health.

Pilot study using machine learning to improve estimation of physical abuse prevalence.

Background: International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes have been shown to underestimate physical abuse prevalence. Machine learning models are capable of efficiently processing a wide variety of data and may provide better estimates of abuse.

Objective: To achieve proof of concept applying machine learning to identify codes associated with abuse.

Racial and ethnic disparities in diagnostic imaging for child physical abuse.

Importance: Racial bias may affect occult injury testing decisions for children with concern for abuse.

Objectives: To determine the association of race on occult injury testing decisions at children's hospitals.

Design: In this retrospective study, we measured disparities in: (1) the proportion of visits for which indicated diagnostic imaging studies for child abuse were obtained; (2) the proportion of positive tests.

Public Benefit Programs and Differential Associations With Child Maltreatment by Race and Ethnicity.

Importance: Public benefit programs, including state spending on local, state, and federal-state partnership programs, have consistently been associated with overall reductions in child protective services (CPS) involvement. Inequities in eligibility and access to benefit programs may contribute to varying associations by race and ethnicity.

Objective: To determine whether associations between state spending on benefit programs and rates of CPS investigations differ by race and ethnicity.

Clinical guideline highlights for the hospitalist: Evaluation for bleeding disorders in suspected child abuse.

Evaluation for Bleeding Disorders in Suspected Child Abuse RELEASE DATE: October 2022 PRIOR VERSION(S): 2013 DEVELOPER: American Academy of Pediatrics FUNDING SOURCE: American Academy of Pediatrics TARGET POPULATION: Children and infants with bruising or bleeding suspicious for physical abuse.

Diagnostic testing for and detection of physical abuse in infants with brief resolved unexplained events.

Background: A Brief Resolved Unexplained Event (BRUE) can be a sign of occult physical abuse.

Objectives: To identify rates of diagnostic testing able to detect physical abuse (head imaging, skeletal survey, and liver transaminases) at BRUE presentation. The secondary objective was to estimate the rate of physical abuse diagnosed at initial BRUE presentation through 1 year of age.

Differences Between Viral Meningitis and Abusive Head Trauma.

Objectives: To evaluate the hypothesis that viral meningitis may mimic abusive head trauma (AHT) by comparing the history of present illness (HPI) and clinical presentation of young children with proven viral meningitis to those with AHT and those with subdural hemorrhage (SDH) only. We hypothesized that significant differences would exist between viral meningitis and the comparison groups.

Methods: We performed a 5-year retrospective case-control study of subjects aged <2 years, comparing those with confirmed viral meningitis (controls) to those with SDH evaluated by the hospital child abuse pediatrics team (cases).

Racial and ethnic differences in pediatric unintentional injuries requiring hospitalization.

Background/objective: This study aims to comprehensively examine racial and ethnic differences in pediatric unintentional injuries requiring hospitalization by age across injury mechanisms.

Study Design: This was a retrospective, nationally representative cross-sectional analysis of discharge data within the 2016 Kids' Inpatient Database for 98,611 children ≤19 years with unintentional injuries resulting in hospitalization. Injury categories included passengers and pedestrians injured in a motor vehicle crash, falls, drownings, burns, firearms, drug and nondrug poisonings, suffocations, and other injuries.

Child Opportunity Index and Changes in Pediatric Acute Care Utilization in the COVID-19 Pandemic.

Background: Pediatric acute care utilization decreased dramatically during the coronavirus disease 2019 (COVID-19) pandemic. This study examined the association between the Child Opportunity Index (COI), a multidimensional neighborhood measure of childhood opportunity, and changes in acute care utilization at US pediatric hospitals during the COVID-19 pandemic compared with the previous 3 years.

Methods: This observational study used administrative data across 41 US-based pediatric hospitals.

State Spending on Public Benefit Programs and Child Maltreatment.

Background: To determine the association between states' total spending on benefit programs and child maltreatment outcomes.

Methods: This was an ecological study of all US states during federal fiscal years 2010-2017. The primary predictor was states' total annual spending on local, state, and federal benefit programs per person living ≤100% federal poverty limit, which was the sum of (1) cash, housing, and in-kind assistance, (2) housing infrastructure, (3) child care assistance, (4) refundable Earned Income Tax Credit, and (5) Medical Assistance Programs.

Late Pre-term Infants with Severe Bronchiolitis and Risk of Asthma by Age 5 Years.

In a prospective, multicenter cohort of infants hospitalized with bronchiolitis, we found infants born late pre-term (ie, gestational age of 34-36.9 weeks) had 35% higher odds of having asthma by age 5 years compared with infants born at full-term.

Association of routine school closures with child maltreatment reporting and substantiation in the United States; 2010-2017.

Background: There exists a presumption that school closures lead to a diminished capacity to detect child maltreatment, but empiric evidence is lacking.

Objective: To determine if child maltreatment reporting and substantiation differ between periods when schools are routinely closed compared to in session.

Participants And Setting: Child maltreatment reporting and substantiation among all U.

The Child Opportunity Index 2.0 and Hospitalizations for Ambulatory Care Sensitive Conditions.

Background And Objectives: Hospitalizations for ambulatory care sensitive conditions (ACSCs) are thought to be avoidable with high-quality outpatient care. Morbidity related to ACSCs has been associated with socioeconomic contextual factors, which do not necessarily capture the complex pathways through which a child's environment impacts health outcomes. Our primary objective was to test the association between a multidimensional measure of neighborhood-level child opportunity and pediatric hospitalization rates for ACSCs across 2 metropolitan areas.

Identification of physical abuse-related hospitalizations in young children: Impact of the transition to ICD-10-CM coding.

Background: Administrative healthcare databases are frequently used for child physical abuse (CPA)-related research and surveillance. In October 2015, the United States transitioned to the International Classification of Diseases, Clinical Modification-10th Revision (ICD-10-CM) coding regimen. ICD-10-CM expands coding related to CPA, including codes to differentiate suspected from confirmed CPA.

Prenatal Substance Exposure and Child Maltreatment: A Systematic Review.

State and federal policies regarding substance use in pregnancy, specifically whether a notification to child protective services is required, continue to evolve. To inform practice, policy, and future research, we sought to synthesize and critically evaluate the existing literature regarding the association of prenatal substance exposure with child maltreatment. We conducted a comprehensive electronic search of PubMed, Web of Science, PsycInfo, CHINAL, Social Work Abstracts, Sociological Abstracts, and Social Services Abstracts.

Variations in Sedated Echocardiography and Association With Repeat Echocardiography in Nonrefractory Kawasaki Disease.

Objectives: Echocardiography performed under sedation allows for better coronary artery visualization in children with Kawasaki disease. We sought to describe hospital-level variability in the percentage of sedated echocardiography (SE) among children with nonrefractory Kawasaki disease (NRKD) and then test its association with repeat echocardiography, length of stay (LOS), and costs.

Methods: We identified children in the Pediatric Health Information System <36 months of age hospitalized with NRKD from March 2010 to February 2017.

Variation in Care and Clinical Outcomes Among Infants Hospitalized With Hyperbilirubinemia.

Objectives: To assess hospital-level variation in laboratory testing and intravenous fluid (IVF) use and examine the association between these interventions and hospitalization outcomes among infants admitted with neonatal hyperbilirubinemia.

Methods: We performed a retrospective multicenter study of infants aged 2 to 7 days hospitalized with a primary diagnosis of hyperbilirubinemia from December 1, 2016, to June 30, 2018, using the Pediatric Health Information System. Hospital-level variation in laboratory and IVF use was evaluated after adjusting for clinical and demographic factors and associated with hospital-level outcomes by using Pearson correlation.

Benefits and Risks of Visitor Restrictions for Hospitalized Children During the COVID Pandemic.

To control the spread of severe acute respiratory syndrome coronavirus 2, the virus responsible for coronavirus disease 2019, many hospitals have strict visitor restriction policies. These policies often prohibit both parents from visiting at the same time or having grandparents or other family members visit at all. We discuss cases in which such policies created ethical dilemmas and possibly called for compassionate exceptions from the general rules.

Intrauterine Substance Exposure and the Risk for Subsequent Physical Abuse Hospitalizations.

Objective: To describe the relative risk for a physical abuse hospitalization among substance exposed infants (SEI) with and without neonatal abstinence syndrome (NAS).

Methods: We created a nationally representative US birth cohort using the 2013 and 2014 Nationwide Readmissions Databases. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify newborns, predictor variables, and subsequent hospitalizations for physical abuse within 6 months of discharge from newborns' birth hospitalization.

Insurance Coverage for Children Impacts Reporting of Child Maltreatment by Healthcare Professionals.

Objectives: Children's insurance coverage, through increased access and use of the healthcare system, may increase the likelihood that healthcare professionals (HCPs) will detect and report child maltreatment. We sought to estimate the association between insurance coverage for children and reporting of child maltreatment by HCPs.

Study Design: We conducted a cross-sectional study of US counties from 2008 to 2015 using data from the US Census Bureau's Small Area Health Insurance Estimates, National Center for Health Statistics, and National Child Abuse and Neglect Data System.

Trends in the Use of Administrative Codes for Physical Abuse Hospitalizations.

This time series study analyzes use of administrative codes for child physical abuse hospitalizations before and after the transition from use of codes to codes.