Background: Diagnostic stewardship is the effort to optimize diagnostic testing to reduce errors while avoiding overtesting and overtreatment. Abdominal pain and appendicitis in children are essential use cases. Delayed diagnosis of appendicitis can be dangerous and even life-threatening, but overtesting is harmful.
View Article and Find Full Text PDFImportance: Higher pediatric readiness has been associated with improved quality and outcomes of care for children. Pediatric emergency care coordinators (PECCs) are a component of pediatric readiness, but the specific association between PECCs and quality-of-care measures is undefined.
Objective: To examine the association between PECC presence and emergency department (ED) performance as reflected by quality-of-care measures.
J Pediatric Infect Dis Soc
December 2024
This study of seven pediatric hospitals identified that the amoxicillin shortage in 2022 resulted in a decline in amoxicillin suspension prescribing by 30.8% with increases in use of amoxicillin non-suspension (+7.9) and broad-spectrum antibiotics.
View Article and Find Full Text PDFBackground And Objectives: Accurate triage at the time of emergency department (ED) presentation is critical for timely acuity assessment and anticipating resource requirements. Commonly, triage is conducted using the Emergency Severity Index (ESI); however, the accuracy of this approach for children in general EDs is uncertain. The purpose of this study was to quantify pediatric triage accuracy in a national sample of ED visits and evaluate whether presentation to a pediatric vs general ED is associated with mistriage.
View Article and Find Full Text PDFStudy Objective: To evaluate for increases in the use and costs of respiratory viral testing in pediatric emergency departments (EDs) because of the COVID-19 pandemic.
Methods: We performed a cross-sectional study using the pediatric health information system. Eligible subjects were children (90 days to 18 years) who were discharged from a pediatric ED and included in the pediatric health information system from October 2016 through March 2024.
Objectives: Hospitalizations for children with medical complexity (CMC) have increased substantially over the past 2 decades and constitute a disproportionate percentage of hospitalization rates and costs among children. We sought to describe the etiology and utilization for hospitalizations of CMC using the Pediatric Clinical Classification System (PECCS).
Methods: Using the 2019 Kids' Inpatient Database, we classified hospitalizations for CMC using the PECCS, which groups diagnoses into mutually exclusive, pediatric-specific categories.
Importance: Classifying hospitals across a wide range of pediatric capabilities, including medical, surgical, and specialty services, would improve understanding of access and outcomes.
Objective: To develop a classification system for hospitals' pediatric capabilities.
Design, Setting, And Participants: This cross-sectional study included data from 2019 on all acute care hospitals with emergency departments in 10 US states that treated at least 1 child per day.
Objectives: Patients with a delayed diagnosis of diabetes are more likely to present in diabetic ketoacidosis (DKA). The objective of this study was to assess the prevalence, risk factors, and consequences of missed pediatric diabetes diagnoses in emergency departments (EDs) potentially leading to DKA.
Methods: Cases of children under 19 years old with a first-time diagnosis of diabetes mellitus presenting to EDs in DKA were drawn from the Healthcare Cost and Utilization Project database.
Objectives: Vital sign measurement and interpretation are essential components of assessment in the emergency department. We sought to assess the completeness of vital signs documentation (defined as a temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation) in a nationally representative sample of children presenting to the emergency department, characterize abnormal vital signs using pediatric advanced life support (PALS) criteria, and evaluate their association with hospitalization or transfer.
Methods: We conducted a retrospective, cross-sectional study using the 2016-2021 National Hospital Ambulatory Medical Care Survey.
Objectives: Multiple viral respiratory epidemics occurred concurrently in 2022 but their true extent is unclear. To aid future surge planning efforts, we compared epidemiology and resource utilization with prepandemic viral respiratory seasons in 38 US children's hospitals.
Methods: We performed a serial cross-sectional study from October 2017 to March 2023.
Objectives: Pediatric readiness varies widely among emergency departments (EDs). The presence of a pediatric emergency care coordinator (PECC) has been associated with improved pediatric readiness and decreased mortality, but adoption of PECCs has been limited. Our objective was to understand factors associated with PECC implementation in general EDs.
View Article and Find Full Text PDFCommunity-acquired pneumonia (CAP) is often considered for children presenting to the emergency department (ED) with respiratory symptoms. It is unclear how often children are diagnosed with CAP following an ED visit for respiratory illness. We performed a retrospective case-control study to evaluate 7-day CAP diagnosis among children 3 months to 18 years discharged from the ED with respiratory illness from 2011 to 2021 and who receive care at 4 hospital-affiliated primary care clinics.
View Article and Find Full Text PDFObjective: To quantify the degree to which health care service area (HCSA) definitions captured hospitalizations and heterogeneity in social determinants of health (SDOH).
Data Sources And Study Setting: Geospatial data from the Centers for Medicare and Medicaid Services, the Census Bureau, and the Dartmouth Institute. Drive-time isochrones from MapBox.
Our goal was to identify predictors of invasive bacterial infection (ie, bacteremia and bacterial meningitis) in febrile infants aged 2-6 months. In our multicenter retrospective cohort, older age and lower temperature identified infants at low risk for invasive bacterial infection who could safely avoid routine testing.
View Article and Find Full Text PDFObjective: To describe variation in costs for emergency department (ED) visits among children and to assess hospital and regional factors associated with costs.
Methods: Cross-sectional study of all ED encounters among children under 18 years in 8 states from 2014 to 2018. The primary outcome was each hospital's mean inflation-adjusted ED costs.
Study Objective: The workload of clinical documentation contributes to health care costs and professional burnout. The advent of generative artificial intelligence language models presents a promising solution. The perspective of clinicians may contribute to effective and responsible implementation of such tools.
View Article and Find Full Text PDFIntroduction: Immediate complications of appendicitis are common, but the prevalence of long-term complications is uncertain.
Methods: We studied all publicly-insured children in the US with uncomplicated or complicated appendicitis in 2018-2019 using administrative claims. The main outcome was late hospital care defined as hospitalization or abdominal procedure within 180 d of an appendicitis discharge, excluding interval appendectomies.
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