Publications by authors named "Marvin B Harper"
Background And Objectives: Blood cultures (BCxs) are often obtained in the initial evaluation of children with fever and acute lower extremity pain; however, their yield in this population is unknown. We aim to describe the prevalence of bacteremia among children presenting to the emergency department (ED) with fever and acute lower extremity pain and identify predictors of bacteremia.
Methods: Cross-sectional review of children aged 1 to 18 years presenting to the ED with fever and acute lower extremity pain between 2010 and 2020.
Unlabelled: Significant variation exists in the management of febrile infants, particularly those between 1 and 2 months of age. An established algorithm for well-appearing febrile infants 1-2 months of age guided clinical care for three decades in our emergency department. With mounting evidence for procalcitonin (PCT) to detect invasive bacterial infection (IBI), we revised our algorithm intending to decrease lumbar punctures (LPs) and antibiotic administration without increasing hospitalizations, revisits, or missed IBI.
View Article and Find Full Text PDFObjectives: Little is known regarding the differences in microbiology associated with cellulitis or abscess with or without lymphangitic streaking. The objective of our study is to assess whether there are differences in the pathogens identified from wound cultures of patients with paronychia with and without associated lymphangitis.
Methods: Retrospective cross-sectional study at a tertiary pediatric emergency department over 25 years.
Objectives: To determine if implementation of an automated sepsis screening algorithm with low positive predictive value led to inappropriate resource utilization in emergency department (ED) patients as evidenced by an increased proportion of children with false-positive sepsis screens receiving intravenous (IV) antibiotics.
Study Design: Retrospective cohort study comparing children <18 years of age presenting to an ED who triggered a false-positive sepsis alert during 2 different 5-month time periods: a silent alert period when alerts were generated but not visible to clinicians and an active alert period when alerts were visible. Primary outcome was the proportion of patients who received IV antibiotics.
Background: Limited data exist regarding the presentation and bacteriology of nonneonatal pediatric breast abscess.
Objective: To determine the bacteriology and characteristic presentation of pediatric breast abscesses in a tertiary care center.
Methods: Cross-sectional study of patients age 1 month to 21 years admitted to a pediatric Emergency Department (ED) between 1996 and 2018 with a breast abscess.
Objective: Alert presentation of clinical decision support recommendations is a common method for providing information; however, many alerts are overridden suggesting presentation design improvements can be made. This study attempts to assess pediatric prescriber information needs for drug-drug interactions (DDIs) alerts and to evaluate the optimal presentation timing and presentation in the medication ordering process.
Methods: Six case scenarios presented interactions between medications used in pediatric specialties of general medicine, infectious disease, cardiology, and neurology.
Background: Relaxation of laws and regulations around privacy and billing during the COVID-19 pandemic provide expanded opportunities to use telehealth to provide patient care at a distance. Many health systems have transitioned to providing outpatient care via telehealth; however, there is an opportunity to utilize telehealth for inpatients to promote physical distancing.
Objective: This article evaluates the use of a rapidly implemented, secure inpatient telehealth program.
Article Synopsis
- Children with hemophilia who have central venous access devices (CVADs) are at a high risk for infections, specifically bacteremia, despite not being immunocompromised.
- A study reviewed 181 febrile cases and found 38% had positive blood cultures, predominantly featuring Staphylococcus aureus and coagulase-negative Staphylococcus, with many strains being susceptible to ceftriaxone.
- The likelihood of positive cultures was significantly higher in hemophilia patients with inhibitors compared to those without, suggesting the need for tailored antimicrobial therapy based on local pathogen profiles.
Objectives: To determine the prevalence of features of viral illness in a national sample of visits involving children tested for group A Streptococcus pharyngitis. Additionally, we sought to derive a decision rule to identify patients with features of viral illness who were at low risk of having group A Streptococcus and for whom laboratory testing might be avoided.
Study Design: Retrospective validation study using data from electronic health records of patients 3-21 years old evaluated for sore throat in a national network of retail health clinics (n = 67 127).
Objectives: To create and evaluate a continuous automated alert system embedded in the electronic health record for the detection of severe sepsis among pediatric inpatient and emergency department patients.
Design: Retrospective cohort study. The main outcome was the algorithm's appropriate detection of severe sepsis.
Objectives: We assessed the clinical characteristics of primary intracranial hypertension (PIH) in children using a newly recommended threshold for cerebrospinal fluid opening pressure (280 mm HO).
Method: Cross-sectional study of patients age ≤21 years who had a lumbar puncture done for evaluation of PIH. Patients were excluded if lumbar puncture was done for a suspected infection, seizure, mental status changes, multiple sclerosis, or Guillain-Barre syndrome.
Variability in antimicrobial use in pediatric ventilator-associated events.
Infect Control Hosp Epidemiol
January 2019
Objective: To assess variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs).
Design: Descriptive retrospective cohort with nested case-control study.
Setting: Pediatric intensive care units (PICUs), cardiac intensive care units (CICUs), and neonatal intensive care units (NICUs) in 6 US hospitals.
Objectives: We sought to identify predictors for a drainable suppurative adenitis [DSA] among patients presenting with acute cervical lymphadenitis.
Methods: A retrospective cross sectional study of all patients admitted to an urban pediatric tertiary care emergency department over a 15 year period. Otherwise healthy patients who underwent imaging for an evaluation of cervical lymphadenitis were included.
Background And Aims: Children with first complex febrile seizure (CFS) are often admitted for observation. The goals of this study were 1) to assess the risk of seizure recurrence during admission, 2) to determine whether early EEG affects acute management.
Design/methods: We retrospectively reviewed a cohort of children 6-60months of age admitted from a Pediatric Emergency Department for first CFS over a 15year period.
Objectives: Because meningitis may trigger seizures, we sought to determine its frequency in children with first-time status epilepticus (SE).
Methods: We performed a retrospective cross-sectional study of children aged 1 month to 21 years who presented to a single pediatric emergency department between 1995 and 2012 with SE and who had a lumbar puncture (LP) performed as part of the diagnostic evaluation. We defined bacterial meningitis as a cerebrospinal fluid (CSF) culture positive for a bacterial pathogen or CSF pleocytosis (CSF white blood cells ≥10 cells/mm) with a blood culture positive for a bacterial pathogen.
Objectives: Children treated with chronic medications are at risk of drug-drug interactions (DDIs) when hospitalized with an acute illness and prescribed new medications. We aimed to measure the prevalence of potential DDIs (pDDIs) among hospitalized children treated with antiepileptic drugs (AEDs) and to evaluate the impact of computerized physician order entry (CPOE) on pDDIs.
Methods: We analyzed a national sample of pediatric hospitalizations from 2005 to 2012 associated with administration of an AED and identified those prescribed a second medication with risk of a DDI.
Electronically stored clinical documents may contain both structured data and unstructured data. The use of structured clinical data varies by facility, but clinicians are familiar with coded data such as International Classification of Diseases, Ninth Revision, Systematized Nomenclature of Medicine-Clinical Terms codes, and commonly other data including patient chief complaints or laboratory results. Most electronic health records have much more clinical information stored as unstructured data, for example, clinical narrative such as history of present illness, procedure notes, and clinical decision making are stored as unstructured data.
View Article and Find Full Text PDFObjective: To measure the impact of electronic medication reconciliation implementation on reports of admission medication reconciliation errors (MREs).
Design: Quality improvement project with time-series design.
Setting: A large, urban, tertiary care children's hospital.
Background And Objective: Among children's hospitals, little is known about how barriers to electronic health record (EHR) adoption are related to meaningful use (MU) incentives. We investigated hospital success with MU incentive payments and determined associations with hospital-reported challenges and characteristics.
Methods: A survey administered to 224 Children's Hospital Association hospitals assessed a variety of potential challenges to achieving meaningful EHR use (eg, lack of access to capital) and specific MU criteria that would be challenging to fulfill (eg, implement clinical decision support rules).
Purpose Of Review: The review describes current evidence on the evaluation of febrile seizures in the acute setting, the need for further outpatient assessment, and predictors regarding long-term outcomes of these patients.
Recent Findings: New evidence has been added in support of limited assessment and intervention: evidence on low utility of lumbar puncture, emergent neuroimaging, and follow-up electroencephalography, as well as low yield for antipyretic prophylaxis and intermittent use of antiepileptic drugs. Finally, there is growing evidence regarding the genetic basis of both febrile seizures and vaccine-related seizures/febrile seizures.
Objective: We determined adoption rates of pediatric-oriented electronic health record (EHR) features by US children's hospitals and assessed perceptions regarding the suitability of commercial EHRs for pediatric care and the influence of the meaningful use incentive program on implementation of pediatric-oriented features.
Materials And Methods: We surveyed members of the Children's Hospital Association. We measured adoption of 19 pediatric-oriented features and asked whether commercial EHRs include key pediatric-focused capabilities.
To determine the yield of neuroimaging in children presenting to the emergency department with acute ataxia in the post-varicella vaccine era, we conducted a cross-sectional study between 1995 and 2013 at a single pediatric tertiary care center. We included children aged 1-18 years evaluated for acute ataxia of <7 days' duration. The main outcome was clinically urgent intracranial pathology defined as a radiologic finding that changed initial management.
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