An Emergency Department Quality Improvement Project to Decrease Lumbar Puncture Rates in Febrile Infants 22 to 28 Days Old.

Introduction: Most providers have routinely performed universal lumbar puncture (LP) on well-appearing, febrile infants 22 to 28 days old. In 2021, the American Academy of Pediatrics recommended clinicians should perform an LP in this age group if inflammatory markers are abnormal. This quality improvement project aimed to decrease LP rates in febrile infants 22 to 28 days old in the emergency department (ED) within 1 year, regardless of race/ethnicity, from a baseline of 87%.

Characterizing Multiple Perpetrator Sexual Assaults in the Adolescent Female Population.

Study Objective: To determine whether differences exist between the acute presentations and post-assault needs of youth presenting to an emergency department (ED) following multiple perpetrator sexual assault (MPSA) compared with those presenting after single perpetrator sexual assault.

Methods: A retrospective cohort study of all female adolescents evaluated in an urban pediatric ED between 2014 and 2021 for acute sexual assault was conducted. Demographic characteristics and assault outcomes were assessed using bivariate analyses.

Improving HIV post-exposure prophylaxis rates after pediatric acute sexual assault.

The purpose of our study was to increase the rate of children with appropriate HIV-PEP regimens among those diagnosed with sexual assault in The Children's Hospital of Philadelphia Emergency Department (ED). The outcome measure was the percent of patients receiving correct HIV-PEP. We retrospectively reviewed 97 charts over 31 months to define the baseline rate of children receiving appropriate HIV-PEP regimens (pre QI-implementation period: 2/2012-8/2014).

Two-Step Process for ED UTI Screening in Febrile Young Children: Reducing Catheterization Rates.

Background And Objectives: Urinary tract infection (UTI) screening in febrile young children can be painful and time consuming. We implemented a screening protocol for UTI in a high-volume pediatric emergency department (ED) to reduce urethral catheterization, limiting catheterization to children with positive screens from urine bag specimens.

Methods: This quality-improvement initiative was implemented using 3 Plan-Do-Study-Act cycles, beginning with a small test of the proposed change in 1 ED area.

Practice variation in screening for sexually transmitted infections with nucleic acid amplification tests during prepubertal sexual abuse evaluations.

Background: Although recent recommendations for children after suspected sexual abuse incorporate nucleic acid amplification tests (NAATs) in algorithms that detect sexually transmitted infections (STIs), screening practices in the community remain uncertain.

Study Objective: We examined screening practices over time and across a variety of pediatric settings for the evaluation of STIs in sexually abused children.

Methods: A consecutive cohort of prepubertal children younger than 11 years of age who were suspected to have been sexually abused were identified between May 2002 and April 2005 at a large tertiary children's hospital and its supporting primary care network.

Prevalence of tubo-ovarian abscess in adolescents diagnosed with pelvic inflammatory disease in a pediatric emergency department.

Objectives: The rate of tubo-ovarian abscess (TOA) in adolescents with pelvic inflammatory disease (PID) is reported to range from 17% to 20%. However, no reports have focused specifically on the adolescent patient presenting to the emergency department (ED), regardless of whether they are treated in the inpatient or outpatient setting. Recent changes in the 2002 Centers for Disease Control and Prevention (CDC) Guidelines for the Treatment of Sexually Transmitted Diseases and sexually transmitted infection screening programs are likely to have impacted both the prevalence of PID and the rates of its complications, particularly TOA.

Unscheduled revisits to a pediatric emergency department: risk factors for children with fever or infection-related complaints.

Objective: Unscheduled revisits (URVs) may serve as markers of quality of care and may be costly both in financial terms as well as in limitations they place on primary care. We performed this study to examine the association between characteristics easily obtainable during an emergency department (ED) visit and URV to identify a subpopulation of children who may warrant interventions to decrease URV.

Methods: This is a case-control study of patients visiting an urban tertiary care pediatric ED for a fever or infectious disease-related complaint.

Return visits to a pediatric emergency department.

Objectives: To determine the incidence of return visits (RVs), types of RVs, and factors associated with RVs to a pediatric emergency department (ED).

Methods: : Retrospective cohort study of patients seen in an urban, tertiary care pediatric ED.

Main Outcome: RV within 48 hours, identified from a computerized log.