Unintentional Pediatric Poisoning Exposures in an Emergency Department: A Comparison of Poison Control Center Referrals and Caregiver Self-Referred Visits.

Objectives: The purpose of this study is to describe the demographics and clinical characteristics of patients referred to a pediatric emergency department (ED) for unintentional poisoning exposures by a poison control center (PCC) compared with patients/caregivers who self-refer.

Methods: The electronic data warehouse at a pediatric hospital was queried from October 1, 2014, to September 30, 2015, for unintentional poisoning-related ED visits and subsequent inpatient admissions. Eligible patients aged 18 years and younger were identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes for pharmaceuticals, non-pharmaceuticalchemicals, fumes/vapors, foreign bodies, adverse food reactions, food poisoning, and bites/stings.

Incidence of supraventricular tachycardia after inhaled short-acting beta agonist treatment in children.

Introduction: Albuterol can trigger supraventricular tachycardia (SVT). The clinical characteristics, incidence, and risk factors of SVT after inhaled SABA treatment in children are currently unknown. Through review of regional care delivery, we will describe cases of SVT during asthma treatment in hospital-based settings, define the incidence of SVT in our population, and evaluate risk factors of SABA-induced SVT.

Implementing a Standardized Constipation-Management Pathway to Reduce Resource Utilization.

Objective: Constipation is commonly diagnosed in our pediatric emergency department (ED). Care has varied significantly, with a heavy reliance on abdominal radiography (AR) for the diagnosis of and inpatient management for bowel cleanout. We implemented a standardized approach to caring for patients presenting to a pediatric ED with symptoms consistent with constipation, emphasizing clinical history, physical examination, less reliance on AR, and standardized home management.

Clinical pharmacokinetics of magnesium sulfate in the treatment of children with severe acute asthma.

Purpose: Intravenous (IV) magnesium sulfate (MgSO) is used as adjunct therapy to treat acute asthma exacerbations. Despite its clinical use, there is a limited understanding of the disposition of magnesium in children.

Methods: To explore the pharmacokinetics (PK) of IV MgSO in this population, we collected retrospective data from 54 children who received IV MgSO for treatment of an acute asthma exacerbation at Primary Children's Hospital in Salt Lake City, UT.

Outcomes After Skin and Soft Tissue Infection in Infants 90 Days Old or Younger.

Background And Objectives: Skin and soft tissue infections (SSTIs) are an increasingly common cause of pediatric hospital visits among infants. The optimal evaluation strategy for younger infants with SSTI is unknown because there is little information about outcomes including risks of concomitant bacterial infections and treatment failure. This study was designed to determine rates of concomitant invasive bacterial infection and hospital revisits for treatment failure as well as factors associated with treatment failure in infants presenting with SSTI.

Variation in Computed Tomography Use for Evaluation of Head Injury in a Pediatric Emergency Department.

Objectives: Recent research has shown significant variation in rates of computed tomography (CT) use among pediatric hospital emergency departments (ED) for evaluation of head injured children. We examined the rates of CT use by individual ED attending physicians for evaluation of head injured children in a pediatric hospital ED.

Methods: We used an administrative database to identify children younger than 18 years evaluated for head injury from January 2011 through March 2013 at our children's hospital ED, staffed by pediatric emergency medicine (PEM) fellowship trained physicians and pediatricians.

Implementing an ultrasound-based protocol for diagnosing appendicitis while maintaining diagnostic accuracy.

Background: The use of ultrasound to diagnose appendicitis in children is well-documented but not universally employed outside of pediatric academic centers, especially in the United States. Various obstacles make it difficult for institutions and radiologists to abandon a successful and accurate CT-based imaging protocol in favor of a US-based protocol.

Objective: To describe how we overcame barriers to implementing a US-based appendicitis protocol among a large group of nonacademic private-practice pediatric radiologists while maintaining diagnostic accuracy and decreasing medical costs.

Hospital Readmissions Among Children With H1N1 Influenza Infection.

Objectives: To describe readmissions among children hospitalized with H1N1 (influenza subtype, hemagglutinin1, neuraminidase 1) pandemic influenza and secondarily to determine the association of oseltamivir during index hospitalization with readmission.

Methods: We reviewed data from 42 freestanding children's hospitals contributing to the Pediatric Health Information System from May through December 2009 when H1N1 was the predominant influenza strain. Children were divided into 2 groups by whether they experienced complications of influenza during index hospitalization.

Effect of gastrojejunal feedings on visits and costs in children with neurologic impairment.

Objective: The objective of the present study was to determine the effect of gastrojejunal tube (GJT) feedings in children with neurologic impairment (NI) on gastroesophageal reflux disease (GERD)- and/or dysfunctional swallowing-related visits and their associated costs.

Methods: The present study is a retrospective cohort study of children with NI and GERD who underwent GJT placement at the study hospital from December 1999 to October 2006. Visits (emergency department, radiology, and hospitalizations) were reviewed from the time of birth until 1 year following GJT placement and classified as either not GERD and/or dysfunctional swallowing related or GERD and/or dysfunctional swallowing related (eg, pneumonias).

Decreasing hospital length of stay for bronchiolitis by using an observation unit and home oxygen therapy.

Importance: Pediatric observation units (OUs) offer the opportunity to safely and efficiently care for common illnesses previously cared for in an inpatient setting. Home oxygen therapy (HOT) has been used to facilitate hospital discharge in patients with hypoxic bronchiolitis. It is unknown how implementation of a hospitalwide bronchiolitis treatment protocol promoting OU-HOT would affect hospital length of stay (LOS).

Determinants of health care use in a population-based leukodystrophy cohort.

Objectives: To determine the costs for children with leukodystrophies and whether high costs are associated with characteristic clinical features or resources use.

Study Design: We determined health care costs in a population cohort of 122 patients with leukodystrophies, including inpatient, outpatient, and emergency department use, during a 9-year period. We analyzed differences in patients with high costs (>85th percentile) and their health care use.

Macrophage activation syndrome in children with systemic lupus erythematosus and children with juvenile idiopathic arthritis.

Objective: To describe patient demographics, interventions, and outcomes in hospitalized children with macrophage activation syndrome (MAS) complicating systemic lupus erythematosus (SLE) or juvenile idiopathic arthritis (JIA).

Methods: We performed a retrospective cohort study using data recorded in the Pediatric Health Information System (PHIS) database from October 1, 2006 to September 30, 2010. Participants had International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for MAS and either SLE or JIA.

Spinal muscular atrophy type 1: are proactive respiratory interventions associated with longer survival?

Context: Spinal muscular atrophy type 1, an autosomal recessive motor neuron disease, is a leading genetic cause of death in infancy and early childhood.

Objective: To determine whether the early initiation of noninvasive respiratory interventions is associated with longer survival.

Design: Single-institution retrospective cohort study identified children with spinal muscular atrophy type 1 from January 1, 2002 to May 1, 2009 who were followed for 2.

Inpatient capacity at children's hospitals during pandemic (H1N1) 2009 outbreak, United States.

Quantifying how close hospitals came to exhausting capacity during the outbreak of pandemic influenza A (H1N1) 2009 can help the health care system plan for more virulent pandemics. This ecologic analysis used emergency department (ED) and inpatient data from 34 US children's hospitals. For the 11-week pandemic (H1N1) 2009 period during fall 2009, inpatient occupancy reached 95%, which was lower than the 101% occupancy during the 2008-09 seasonal influenza period.

Neurologically intact children with an isolated skull fracture may be safely discharged after brief observation.

Purpose: The management of children presenting with an isolated skull fracture (ISF) posttrauma is highly variable. We sought to estimate the risk of neurologic deterioration in children with a Glasgow coma score (GCS) 15 and ISF to reduce unnecessary hospital admissions.

Methods: A retrospective review at a level I pediatric trauma referral center was conducted for patients with ISF on head computed tomography from 2003 to 2008.

Resource burden at children's hospitals experiencing surge volumes during the spring 2009 H1N1 influenza pandemic.

Objectives: The objective was to describe the emergency department (ED) resource burden of the spring 2009 H1N1 influenza pandemic at U.S. children's hospitals by quantifying observed-to-expected utilization.

Improving transitions of care at hospital discharge--implications for pediatric hospitalists and primary care providers.

Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs.

Hospital admission medication reconciliation in medically complex children: an observational study.

Objective: To evaluate admission medication reconciliation in children with medically complex conditions (MCC) by determining the availability and accuracy of five information sources and characterising admitting order errors.

Design: Prospective quality improvement cohort study.

Setting: Tertiary care free-standing children's hospital in the Intermountain west, USA.

Impact of fundoplication versus gastrojejunal feeding tubes on mortality and in preventing aspiration pneumonia in young children with neurologic impairment who have gastroesophageal reflux disease.

Objective: Aspiration pneumonia is the most common cause of death in children with neurologic impairment who have gastroesophageal reflux disease. Fundoplications and gastrojejunal feeding tubes are frequently employed to prevent aspiration pneumonia in this population. Which of these approaches is more effective in preventing aspiration pneumonia and/or improving survival is unknown.

Informing the front line about common respiratory viral epidemics.

The nature of clinical medicine is to focus on individuals rather than the populations from which they originate. This orientation can be problematic in the context of acute healthcare delivery during routine winter outbreaks of viral respiratory disease where an individuals likelihood of viral infection depends on knowledge of local disease incidence. The level of interest in and perceived utility of community and regional infection data for front line clinicians providing acute care is unclear.

Children with chronic complex medical illnesses: Is inpatient care family-centered?

Background: Families of children with complex chronic medical illnesses (CCMI) benefit from coordinated, family-centered healthcare.

Objective: Compare parental perceptions of inpatient family-centered care for children with CCMI in structured clinical programs (SCPs) with those who are not in SCPs.

Design/methods: Cross-sectional mail survey of parents of children with CCMIs using the 56-item Measure of Processes of Care (MPOC) to rate perceptions of family-centered healthcare.

Quality of life of children with neurological impairment who receive a fundoplication for gastroesophageal reflux disease.

Background: Children with neurological impairment (NI) commonly have gastroesophageal reflux disease (GERD) treated with a fundoplication. The impact of this procedure on quality of life is poorly understood.

Objectives: To examine the quality of life of children with NI who have received a fundoplication for GERD and of their caregivers.

The effect of a computerized reminder system on the prevention of postoperative venous thromboembolism.

Study Objective: To measure the effect of an altered process of care, directed by a computerized reminder system, on rates of symptomatic postoperative venous thromboembolism.

Design: Comparisons of preintervention and postintervention measurements.

Setting: A university-affiliated community hospital in Utah.

Detection of pediatric respiratory and gastrointestinal outbreaks from free-text chief complaints.

We conducted a retrospective study to ascertain the potential of free-text chief complaints collected in pediatric emergency departments to serve as surveillance data for early detection of outbreaks. We determined that automatically coded chief complaint data provide a signal that reflects outbreaks in a population of children less than five years of age. Using the Exponentially Weighted Moving Average (EWMA) detection algorithm, we measured the timeliness, sensitivity, and specificity of free-text chief complaints for predicting outbreaks of pediatric respiratory and gastrointestinal illness.