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Articles 1 - 30 of 90
Full-Text Articles in Pediatrics
Exploring How Parental Involvement Impacts Police Encounters And Delinquent Behaviors Among Black Adolescent Girls, Danielle Porter, Elizabeth A. Otto, Dyamon Brown, Jasmine Alli, Robyn Douglas, Noni Gaylord-Harden
Exploring How Parental Involvement Impacts Police Encounters And Delinquent Behaviors Among Black Adolescent Girls, Danielle Porter, Elizabeth A. Otto, Dyamon Brown, Jasmine Alli, Robyn Douglas, Noni Gaylord-Harden
Presentations
Adolescents’ contact with police is a complex outcome that is influenced by both individual behavior and the broader social context. Specifically, while delinquent behavior can lead to more police contact (Crutchfield et al., 2012), hyper-surveillance often occurs in marginalized communities, increasing unjustified police contact for youth of color (Campos-Manzo et al., 2020; Geller, 2021). Indeed, racial disparities in police contact during adolescence persist even after accounting for delinquent behavior (Campos-Manzo et al., 2020; Crutchfield et al., 2012). Thus, it is important to identify factors that may protect Black youth from contact with police. Parental involvement refers to parents’ active and …
Antibiotic-Pathogen Concordance In Pediatric Complicated Community-Acquired Pneumonia, Makenna Steger Md, Marina Dantas Md, Mscr, Berina Karisik Do, Smit Shah, Alaina Burns Pharmd, Jessica Markham
Antibiotic-Pathogen Concordance In Pediatric Complicated Community-Acquired Pneumonia, Makenna Steger Md, Marina Dantas Md, Mscr, Berina Karisik Do, Smit Shah, Alaina Burns Pharmd, Jessica Markham
Presentations
Background Complicated community-acquired pneumonia (cCAP)—defined by effusion, empyema, abscess, cavitation, or necrosis—is associated with worse outcomes than uncomplicated pneumonia. Methicillin resistant Staphylococcus aureus (MRSA) data in cCAP are limited and often merged with uncomplicated cases. Although guidelines recommend MRSA coverage only in select cases, it is empirically used in >70% of encounters. Lack of pathogen identification likely drives overuse due to diagnostic uncertainty. Clarifying Member of AAP, APA, APS, SPR, ASPN, or PIDS? PIDS JM Jessica Markham, MD, MSc Position: Associate Professor of Pediatrics Organization: Children's Mercy Hospitals and Clinics Email: [email protected] Role: Co-Author Disclosure Status: Complete Disclosure: Nothing to …
Eeg Features And Rotterdam Head Ct Score Predict Early Favorable Outcome In Pediatric Severe Tbi, Xuexin Lu
Eeg Features And Rotterdam Head Ct Score Predict Early Favorable Outcome In Pediatric Severe Tbi, Xuexin Lu
Presentations
INTRODUCTION Accurate prognostication after pediatric severe TBI (sTBI) remains challenging. We examined the utility of continuous EEG (cEEG) and Rotterdam head CT score in predicting short-term favorable outcome. METHODS 7-yr (01/2018-12/2024) retrospective study of children aged 1.5-18 yrs admitted to our PICU with sTBI and receiving cEEG monitoring per institutional protocol. Early favorable outcome was defined as Pediatric Cerebral Performance Category scale 1-3 at PICU discharge. cEEG features (background, sleep architecture, reactivity, and seizure) during the 1st 12-hrs of monitoring and initial Rotterdam head CT scores were recorded. Demographics, GCS score, pupillary reactivity, injury severity score (ISS), clinical seizure, cardiac …
Sepsis At Children's Mercy: A Descriptive Study, Katlyn Mayer, Leslie Hueschen, Grace E. Arends Md, Ashley Sherman
Sepsis At Children's Mercy: A Descriptive Study, Katlyn Mayer, Leslie Hueschen, Grace E. Arends Md, Ashley Sherman
Presentations
No abstract provided.
Discontinuous Or Attenuated Background, Absent Sleep Architecture, Absent Reactivity, And Presence Of Subclinical Seizures On Continuous Electroencephalography Are Associated With Unfavorable Short-Term Outcome Following Pediatric Severe Traumatic Brain Injury, Xuexin Lu, Ara Hall, Yong Y. Han, Madeline Burdick, Avner Moeded, Isabella Boedefeld, Christian Kaufman, Jessica S. Wallisch
Discontinuous Or Attenuated Background, Absent Sleep Architecture, Absent Reactivity, And Presence Of Subclinical Seizures On Continuous Electroencephalography Are Associated With Unfavorable Short-Term Outcome Following Pediatric Severe Traumatic Brain Injury, Xuexin Lu, Ara Hall, Yong Y. Han, Madeline Burdick, Avner Moeded, Isabella Boedefeld, Christian Kaufman, Jessica S. Wallisch
Presentations
BACKGROUND/PURPOSE: Accurate prognostication following pediatric severe traumatic brain injury (sTBI) remains challenging. Adult neuroprognostication guidelines recommend the use of prediction models that have not yet been validated in pediatric patients. We hypothesized certain continuous electroencephalography (cEEG) characteristics would be associated with unfavorable short-term outcome. METHODS: This was an IRB-approved, 7-year retrospective cohort study of children aged 1.5-18 years admitted to our PICU from 01/2018-12/2024 with sTBI and receiving cEEG monitoring per institutional standard management protocol. cEEG patterns (background, sleep architecture, reactivity, and electrographic seizure) during the first 12-hours of monitoring were analyzed for association with unfavorable short-term outcome at PICU …
Variation A Blood Culture Testing For Three Common Infections, Smit Shah, Jennifer Goldman, Matt Hall, Jillian Cotter, Samantha A. House, Matthew J. Molloy, Michelle Polich, Michael J. Steiner, John R. Stephens, Michael J. Tchou, Ronald J. Teufel Ii, Irma Ugalde, Andrew Yu, Jessica Markham
Variation A Blood Culture Testing For Three Common Infections, Smit Shah, Jennifer Goldman, Matt Hall, Jillian Cotter, Samantha A. House, Matthew J. Molloy, Michelle Polich, Michael J. Steiner, John R. Stephens, Michael J. Tchou, Ronald J. Teufel Ii, Irma Ugalde, Andrew Yu, Jessica Markham
Presentations
Background: Routine blood culture (BC) testing in uncomplicated community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) has demonstrated low clinical utility. Objectives: To evaluate hospital-level BC testing trends and their association with clinical outcome differences for children hospitalized with CAP, SSTI, and UTI. Methods: This retrospective cohort study used the Pediatric Health Information System database to identify hospitalizations of children aged 3 months-18 years admitted with CAP, SSTI, or UTI from 2016-2023. We excluded patients with complicated infections, medical complexity, ICU admission, or length of stay (LOS) >7 days. Hospital-level BC testing rates were …
Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenburg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly
Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenburg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly
Presentations
Background: Limiting antibiotic duration is one of the pillars of antimicrobial stewardship programs (ASP) as it reduces unnecessary antibiotic exposure. In our emergency department (ED), >90% of respiratory infections are treated with first-line guideline-recommended antibiotics; however, duration continues to be prolonged especially for community acquired pneumonia (CAP) and acute bacterial rhinosinusitis (ABRS). Institutional guidance recommends shortening antibiotic durations to 3-5 days for CAP and 5-7 days for ABRS, however only 13% of discharged ED patients receive the recommended duration. Objective: Our aim is to increase the percentage of children discharged home from the ED with a diagnosis of CAP or …
More Of Less: Optimizing Opioid Prescriptions For Acute Fractures In The Emergency Department At A Children’S Hospital, Mitch Kinkor, Spencer Young, Colton Schwarz, Nicholas Clark, Michelle Dephillips, Elizabeth Edmundson, Ryan Mcdonough, Warren Teachout
More Of Less: Optimizing Opioid Prescriptions For Acute Fractures In The Emergency Department At A Children’S Hospital, Mitch Kinkor, Spencer Young, Colton Schwarz, Nicholas Clark, Michelle Dephillips, Elizabeth Edmundson, Ryan Mcdonough, Warren Teachout
Presentations
Introduction: Deaths related to drug overdose are at record highs, with over 110,000 recorded from May 2022-2023.1 75% of drug overdose deaths can be attributed to opioids.1 Pediatric opioid exposure is significant, with 406,000 American teens reporting illicit opioid use in 2022.2 Increased prescription opioids in circulation leads to increased opportunity for ingestion by children and adolescents. Current literature suggests most pediatric patients may only use one-two days’ worth of opioid doses prescribed for acute pain control, with the rest of prescribed doses going unused.3 From 2022-2023 in the Children’s Mercy Emergency Department (ED), 48% of children prescribed opioids for …
Protective Factors Against Child Maltreatment Among Postpartum Mothers, Maggie Mann, Elizabeth Grady, Matthew Hall, Cristy Toburen, Ann Mattison, Jennifer Anderson, Katie J. Hocker, Francesca Donohue, Heather Williams, Jessica Sprague-Jones, James Anderst, Henry T. Puls
Protective Factors Against Child Maltreatment Among Postpartum Mothers, Maggie Mann, Elizabeth Grady, Matthew Hall, Cristy Toburen, Ann Mattison, Jennifer Anderson, Katie J. Hocker, Francesca Donohue, Heather Williams, Jessica Sprague-Jones, James Anderst, Henry T. Puls
Presentations
No abstract provided.
Aht Diagnoses: The Influences Of Clinical Presentation And Evidence Of Impact, Ruairi Smith-Dewey, Angela Bachim, Colleen Bressler, Kristine A. Campbell, Lori Frasier, Chris Greenley, Danielle Horton, Nicole R. Johnson, Jan Leonard, Megan M. Letson, Dan M. Lindberg, Caitlin R. Mcnamara, Shalon M. Nienow, Ashley K. Sherman, Joanne N. Wood, James Anderst Md, Msci
Aht Diagnoses: The Influences Of Clinical Presentation And Evidence Of Impact, Ruairi Smith-Dewey, Angela Bachim, Colleen Bressler, Kristine A. Campbell, Lori Frasier, Chris Greenley, Danielle Horton, Nicole R. Johnson, Jan Leonard, Megan M. Letson, Dan M. Lindberg, Caitlin R. Mcnamara, Shalon M. Nienow, Ashley K. Sherman, Joanne N. Wood, James Anderst Md, Msci
Presentations
In cases where Child Abuse Pediatricians (CAPs) diagnose abusive head trauma (AHT) in young children, some factors surrounding the diagnosis have been challenged including causative shaking, necessity of external signs of impact, or concomitant suspicious injuries. Evaluation of CAP diagnoses in children with subdural hemorrhage (SDH) can give insight into factors related to the frequency of abusive head trauma (AHT) diagnoses. Additionally, characterization of those with SDH+CSI without evidence of impact may inform controversies around AHT diagnoses. Objective We aim to compare CAP diagnoses in subjects with SDH across clinical presentations and in the context of evidence of head impact. …
Mental Health Diagnoses Amongst Children With Complex Chronic Medical Conditions, Maria Newmaster, Matt Hall, Adrienne Deporre, Molly Krager, Cy Nadler, Laura Plencner, Henry T. Puls
Mental Health Diagnoses Amongst Children With Complex Chronic Medical Conditions, Maria Newmaster, Matt Hall, Adrienne Deporre, Molly Krager, Cy Nadler, Laura Plencner, Henry T. Puls
Presentations
Background: Mental health (MH) diagnoses are known to complicate outcomes of underlying medical conditions in pediatrics, but the prevalence of MH diagnoses across the array of medically complex and/or chronic conditions are not well known. Objective: To compare prevalence of MH diagnoses across levels of medical complexity and chronicity, and identify factors associated with MH diagnoses among children with complex chronic conditions (CCC). Methods: This retrospective cross-sectional study included children ages 5-17 years with at least 11 months of continuous Medicaid enrollment in 2022 from the Merative Marketscan Medicaid Database which collects data from all children with Medicaid in the …
Variation In Blood Culture Testing For Three Common Infections, Smit Shah, Jennifer Goldman, Matt Hall, Jillian Cotter, Samantha A. House, Matthew J. Molloy, Michelle Polich, Michael J. Steiner, John R. Stephens, Michael J. Tchou, Ronald J. Teufel Ii, Irma Ugalde, Andrew Yu, Jessica L. Markham
Variation In Blood Culture Testing For Three Common Infections, Smit Shah, Jennifer Goldman, Matt Hall, Jillian Cotter, Samantha A. House, Matthew J. Molloy, Michelle Polich, Michael J. Steiner, John R. Stephens, Michael J. Tchou, Ronald J. Teufel Ii, Irma Ugalde, Andrew Yu, Jessica L. Markham
Presentations
Background: Routine blood culture (BC) testing in uncomplicated community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) has demonstrated low clinical utility. Objectives: To evaluate hospital-level BC testing trends and their association with clinical outcome differences for children hospitalized with CAP, SSTI, and UTI. Methods: This retrospective cohort study used the Pediatric Health Information System database to identify hospitalizations of children aged 3 months-18 years admitted with CAP, SSTI, or UTI from 2016-2023. We excluded patients with complicated infections, medical complexity, ICU admission, or length of stay (LOS) >7 days. Hospital-level BC testing rates were …
Comparative Analysis Of Oxygenators And Anticoagulation Strategies In Neonatal And Pediatric Ecmo Patients, Debra E. Newton, Johanna I. Orrick
Comparative Analysis Of Oxygenators And Anticoagulation Strategies In Neonatal And Pediatric Ecmo Patients, Debra E. Newton, Johanna I. Orrick
Presentations
Background: Due to supply chain challenges, our institution transitioned from Pediatric Quadrox oxygenators to Nautilus oxygenators for neonatal and pediatric extracorporeal membrane oxygenation (ECMO) patients. During this transition, variations in anticoagulation results were observed with bivalirudin, the first-line anticoagulant, in patients weighing less than 8 kg. This study aimed to evaluate heparin as an alternative anticoagulant in this patient population utilizing Nautilus oxygenators. Methods: A retrospective analysis was conducted on 29 neonatal and pediatric ECMO patients (weight range: 2.3–6.1 kg). Patients were divided into three groups based on oxygenator and anticoagulant type: · Group 1: Quadrox with bivalirudin (n=11) · …
Ultralow-Field Mri Feasibility In Pediatric Ecmo Patients, Jessica S. Wallisch, Asdis Finnsdottir Wagner, Maura Sien, John M. Daniel Iv, Allison Taber, Nathan S. Artz, Sherwin S. Chan
Ultralow-Field Mri Feasibility In Pediatric Ecmo Patients, Jessica S. Wallisch, Asdis Finnsdottir Wagner, Maura Sien, John M. Daniel Iv, Allison Taber, Nathan S. Artz, Sherwin S. Chan
Presentations
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is used to treat refractory cardiopulmonary failure. Survival has significantly improved, yet high rates of acute brain injury (ABI) in this population results in significant morbidity and mortality. Currently available imaging modalities [ultrasound (US), computed tomography (CT)] have low detection of early hypoxic-ischemic and cerebrovascular-type injuries, which delays the diagnosis of ABI while on ECMO. CT sensitivity increases only when it is too late to effectively intervene. High-field (>=1.5 Tesla) magnetic resonance imaging (MRI) is the gold standard to diagnose pediatric ischemic brain injury but is not compatible with ECMO. An ultralow-field (0.064 T) …
Ecmo In Pediatric Oncologic And Hsct Patients: A Descriptive And Comparative Analysis, Michelle Brown
Ecmo In Pediatric Oncologic And Hsct Patients: A Descriptive And Comparative Analysis, Michelle Brown
Presentations
Introduction: Pediatric oncologic and hematopoietic stem cell transplant (HSCT) recipients are vulnerable to development of respiratory failure due to chemotherapy, radiation, surgery, and immunosuppression. Yet, providing extracorporeal membrane oxygenation (ECMO) support in these patient populations remains controversial with heterogenous utilization across pediatric institutions. The aim of this study is to characterize and compare outcomes in pediatric oncologic and HSCT patients with respiratory failure in the presence and absence of ECMO support. Methods: This study was a retrospective matched comparative analysis between two tertiary care pediatric institutions. Patients less than 18 years old with an underlying oncologic diagnosis and/or HSCT with …
Preventing Migration Of Esophageal Silicone Covered Self-Expanding Metal Stent Using Dental Floss In A Pediatric Patient, Sofia Colon Guzman, Nadia Ibrahimi, Amornluck Krasaelap
Preventing Migration Of Esophageal Silicone Covered Self-Expanding Metal Stent Using Dental Floss In A Pediatric Patient, Sofia Colon Guzman, Nadia Ibrahimi, Amornluck Krasaelap
Presentations
Temporary esophageal stents are an important and effective treatment for benign esophageal strictures, such as those caused by caustic ingestions. Fully covered self-expanding metal stents (FCSEMS) provide the benefit of continuous dilation pressure over longer periods of time compared to bougie or balloon dilation. However, stent migration is the most common complication and can be observed in up to 40% of patients, especially with FCSEMS and in refractory strictures. Typically, the stent is secured by using clips or suturing devices. However, we present a case where traditional methods of securing a stent were not possible due to the location of …
Decentralized Clinical Trials (Dcts): Facilitators & Barriers For A Pediatric Research Site, Abby Kietzman
Decentralized Clinical Trials (Dcts): Facilitators & Barriers For A Pediatric Research Site, Abby Kietzman
Presentations
In 2020, the COVID-19 pandemic drastically altered the way clinical research is conducted through a widespread adoption of telemedicine practices. Using telehealth/telemedicine services allowed researchers to conduct “decentralized clinical trials”, or DCTs, for all or portions of study protocol procedures while maintaining safety measures implemented for pandemic control. However, current review of available literature details the explosion in use of decentralized clinical trials, resulting in gaps in evidence-based outcomes and lack of standardization across research entities. While sponsors and contract research organizations (CROs) tend to lead the charge around adoption of DCTs, research sites are hesitant to make the transition …
Early Versus Staged Repair Of Pulmonary Atresia With Ventricular Septal Defect Without Mapcas: A Phis Analysis, Mohamed Aashiq Abdul Ghayum, Brian R. Lee, James O'Brien, Edo Bedzra
Early Versus Staged Repair Of Pulmonary Atresia With Ventricular Septal Defect Without Mapcas: A Phis Analysis, Mohamed Aashiq Abdul Ghayum, Brian R. Lee, James O'Brien, Edo Bedzra
Presentations
Objective: The management of Pulmonary Atresia and Ventricular Septal Defect (PA/VSD) without Major Aortopulmonary Collaterals (MAPCAs) is variable. This study aims to describe the practice patterns, choice of interventions, and outcomes of patients treated using various surgical strategies. Methods: Data from the Public Health Information System (PHIS) database was analyzed for patients with a diagnosis of PA/VSD without MAPCAs who followed a two-ventricle strategy between 2003 and 2023. Patients were categorized based on the initial surgical approach into four groups: single-stage early repair, ductal stent, systemic to pulmonary artery shunt, and right ventricle to pulmonary artery (RV-PA) connection. Outcomes, including …
Minimally Invasive Repair Of Pectus Excavatum Without Stabilizers Does Not Result In Increased Bar Displacement Or Other Post-Operative Complications, Meredith Elman, Seth Saylors, Ismael Elhalaby, Pablo Aguayo
Minimally Invasive Repair Of Pectus Excavatum Without Stabilizers Does Not Result In Increased Bar Displacement Or Other Post-Operative Complications, Meredith Elman, Seth Saylors, Ismael Elhalaby, Pablo Aguayo
Presentations
Introduction/Purpose Since the Nuss procedure was first performed in the 1990s, surgeons have adopted various modifications and techniques that vary by practice to optimize patient outcomes and minimize complications following pectus excavatum repair. Bar dislocation is a particularly dreaded complication, and as such, many Nuss bars are secured using unilateral or bilateral stabilizers. However, additional foreign body use can be associated with increased morbidity such as infection at stabilizer sites (~3% incidence), and pain attributed to stabilizer presence. Beginning in 2020, individuals in our practice did not place stabilizers in patients undergoing minimally invasive repair of pectus excavatum (MIRPE), and …
Variation In Systemic Corticosteroid Prescribing During Asthma-Related Hospitalizations Across Children’S Hospitals, Sian Best, Matt Hall, Jessica L. Bettenhausen, Shelby Chesbro, Nicholas Clark, Megan Collins, Adrienne Deporre, Jonathan Ermer, Bridgette Jones, Leah Jones, Jessica Markham, Elisha Mccoy, Maria Newmaster, Laura Plencner, Henry T. Puls, Smit Shah, Kathryn Kyler
Variation In Systemic Corticosteroid Prescribing During Asthma-Related Hospitalizations Across Children’S Hospitals, Sian Best, Matt Hall, Jessica L. Bettenhausen, Shelby Chesbro, Nicholas Clark, Megan Collins, Adrienne Deporre, Jonathan Ermer, Bridgette Jones, Leah Jones, Jessica Markham, Elisha Mccoy, Maria Newmaster, Laura Plencner, Henry T. Puls, Smit Shah, Kathryn Kyler
Presentations
Background: Asthma exacerbations are a leading cause of pediatric hospitalizations, and systemic corticosteroids remain a key component of inpatient treatment. Emergency department-focused studies have shown dexamethasone to be equivalent to prednisone/prednisolone in terms of outcomes such as readmission rates, but less is known about the trends in dexamethasone use versus other systemic corticosteroids, and associated outcomes in the inpatient setting. Objectives/Goal: To describe variability and trends in inpatient systemic corticosteroid prescribing practices for acute asthma exacerbations, and to determine associations between the prescribed steroid and hospitalization outcomes. Methods/Design: This retrospective cross-sectional study utilized the PHIS database to examine patients aged …
Call Me Telephone Triage Skills For Pediatricians Across Multiple Settings, Cody Clary, Jonathan Ermer, Rebecca Callahan, Kayla Heller, Luke Stephens, Margaret Kirkpatrick, Nehal Parikh, Cody Tigges, Madhuradhar Chegondi
Call Me Telephone Triage Skills For Pediatricians Across Multiple Settings, Cody Clary, Jonathan Ermer, Rebecca Callahan, Kayla Heller, Luke Stephens, Margaret Kirkpatrick, Nehal Parikh, Cody Tigges, Madhuradhar Chegondi
Presentations
Come explore current evidence surrounding telephone triage skills across a variety of settings and learn ways to teach these valuable skills while promoting best practices. Outpatient pediatricians, hospitalists, ICU physicians and ED providers all have telephone calls incorporated into their work. Often physicians are operating with very little training in this area, and methodology about teaching these skills to pediatric trainees is limited. We will highlight educational innovations at a variety of programs designed to improve resident and fellow education, sharing our results and providing opportunities for others to design their own content relevant to their own practice. Participants will …
Variation In Systemic Corticosteroid Prescribing During Asthma-Related Hospitalizations Across Children's Hospitals, Sian Best, Matt Hall, Jessica L. Bettenhausen, Shelby Chesbro, Nicholas Clark, Megan Collins, Adrienne G. Deporre, Jonathan Ermer, Bridgette Jones, Leah Jones, Jessica Markham, Elisha Mccoy, Maria Newmaster, Laura Plencner, Henry T. Puls, Smit Shah, Kathryn Kyler
Variation In Systemic Corticosteroid Prescribing During Asthma-Related Hospitalizations Across Children's Hospitals, Sian Best, Matt Hall, Jessica L. Bettenhausen, Shelby Chesbro, Nicholas Clark, Megan Collins, Adrienne G. Deporre, Jonathan Ermer, Bridgette Jones, Leah Jones, Jessica Markham, Elisha Mccoy, Maria Newmaster, Laura Plencner, Henry T. Puls, Smit Shah, Kathryn Kyler
Presentations
Asthma exacerbations are a leading cause of pediatric hospitalizations, and systemic corticosteroids remain a key component of inpatient treatment. Emergency department-focused studies have shown dexamethasone to be equivalent to prednisone/prednisolone in terms of outcomes such as readmission rates, but less is known about the trends in dexamethasone use versus other systemic corticosteroids, and associated outcomes in the inpatient setting. Objective (216) To describe variability and trends in inpatient systemic corticosteroid prescribing practices for acute asthma exacerbations, and to determine associations between the prescribed steroid and hospitalization outcomes. Design/Methods (949) This retrospective cross-sectional study utilized the PHIS database to examine patients …
Testing For Bleeding Disorders In Child Abuse: Adherence To Aap Recommendations And Results Of Testing, Lyndsey Hultman, Angela Doswell, Henry T. Puls, Shannon L. Carpenter, Angela Bachim, Kristine Campbell, Daniel Lindberg, Joanne Wood, James Anderst
Testing For Bleeding Disorders In Child Abuse: Adherence To Aap Recommendations And Results Of Testing, Lyndsey Hultman, Angela Doswell, Henry T. Puls, Shannon L. Carpenter, Angela Bachim, Kristine Campbell, Daniel Lindberg, Joanne Wood, James Anderst
Presentations
Background: The American Academy of Pediatrics (AAP) recommends evaluations for bleeding disorders in children who have bruising and/or intracranial hemorrhage (ICH) concerning for abuse. Adherence to these recommendations is not known nor are the frequencies of identification of bleeding disorders or laboratory findings suggestive of a bleeding disorder. Objective: Using a multicenter research network (CAPNET), the objectives of this study were to characterize (1) the adherence to AAP recommendations for bleeding disorder testing in total and across CAPNET sites and (2) the frequency of identification of specific bleeding disorders and laboratory values concerning for bleeding disorders. Methods: We performed a …
Improving Frequency Of Peer Review Of Abnormal Genital Exam Findings In Patients Undergoing Sexual Abuse Evaluation, Lyndsey Hultman, Terra N. Frazier, Jennifer Hansen
Improving Frequency Of Peer Review Of Abnormal Genital Exam Findings In Patients Undergoing Sexual Abuse Evaluation, Lyndsey Hultman, Terra N. Frazier, Jennifer Hansen
Presentations
Background/Objectives: 2023 Child Advocacy Center (CAC) accreditation standards require that “all medical professionals providing services to CAC clients must demonstrate that 100% of all findings deemed abnormal or “diagnostic” of trauma from sexual abuse have undergone expert review by an advanced medical consultant”. Prior to program implementation, scheduled Case Review occurred among the authors’ institution child abuse pediatricians (CAPs), but typical practice was to review cases upon CAP request. The authors’ institution faced practice standard implementation barriers of high case volumes and collaboration with multiple different CACs. Our primary aim was to increase peer review of abnormal exams from a …
Antimicrobial Duration Stewardship Project: A Qi Approach, Joshua Saucedo, Rana El Feghaly, Amanda Nedved, Leslie Hueschen, Marsha Dannenburg, Tanis Stewart, Patty Philips, Jennifer Floyd
Antimicrobial Duration Stewardship Project: A Qi Approach, Joshua Saucedo, Rana El Feghaly, Amanda Nedved, Leslie Hueschen, Marsha Dannenburg, Tanis Stewart, Patty Philips, Jennifer Floyd
Presentations
A QI project aimed at increasing the percentage of children discharged home from the emergency department with a diagnosis of community acquired pneumonia (CAP) or acute bacterial rhinosinusitis (ABRS) treated with an optimal antibiotic duration (5 days or less for CAP, 7 days or less for ABRS) from 22% to 70% by July 2025. Additionally, assess for differences in care based on demographic and socioeconomic factors such as the area deprivation index. National guidelines and CMH clinical pathways recommend short antibiotic durations (5-7 days) for most infections (5 days for community acquired pneumonia, 5-7 days for acute bacterial rhinosinusitis). At …
Single-Step Collagen-Elastin Dermal Matrix With Split-Thickness Skin Grafting For Keloid Burn Scars: A Case Series, Meredith Elman, Pablo Aguayo
Single-Step Collagen-Elastin Dermal Matrix With Split-Thickness Skin Grafting For Keloid Burn Scars: A Case Series, Meredith Elman, Pablo Aguayo
Presentations
Introduction Keloids may pose significant difficulty to affected patients: they can be painful, itchy, impact mobility if they cross joints, and most disruptively, can be physically disfiguring and cause emotional distress. While multiple treatments exist, none reliably provide scar resolution, and up to 100% of keloids return after surgical excision. MatriDerm is a dermal replacement scaffold that has shown previous efficacy in management of a variety of acute and chronic wounds in adults, including burns. In this two patient case series, we aim to demonstrate the efficacy of single-step application of MatriDerm dermal substitute with split-thickness skin grafting in the …
Large Single Center Experience With Extubation During Neonatal And Pediatric Extracorporeal Membrane Oxygenation, Cara Holton, Johanna I. Orrick, Debra E. Newton, Jenna Miller
Large Single Center Experience With Extubation During Neonatal And Pediatric Extracorporeal Membrane Oxygenation, Cara Holton, Johanna I. Orrick, Debra E. Newton, Jenna Miller
Presentations
Introduction: Extubation of neonatal and pediatric patients supported with extracorporeal membrane oxygenation (ECMO) may avoid ventilator induced lung injury, decrease neurosedative exposure, and improve rehabilitation and mobility. Few studies have evaluated incidence and outcomes of pediatric patients extubated during ECMO. Methods: A single-center retrospective cohort study was performed to describe our experience with extubation on ECMO. All patients extubated on ECMO from 2013-2022 were included. Patients who had a tracheostomy prior to ECMO cannulation were excluded. Patients who had a tracheostomy placed during their ECMO run were included if extubation took place prior to tracheostomy placement. Results: Forty patients were …
Successful Hepatectomy, Anhepatic State, And Liver Transplant On Ecmo, Jenna Miller, Kari L. Davidson, Bhargava Mullapudi, Richard J. Hendrickson, Ryan T. Fischer, Lisa Conley, Wes Ware, Michelle Mckain, Tara Benton
Successful Hepatectomy, Anhepatic State, And Liver Transplant On Ecmo, Jenna Miller, Kari L. Davidson, Bhargava Mullapudi, Richard J. Hendrickson, Ryan T. Fischer, Lisa Conley, Wes Ware, Michelle Mckain, Tara Benton
Presentations
We discuss the case of a 13-month-old previously healthy male who presented with acute liver failure (ALF) of unknown etiology. He progressed to fulminant cardiopulmonary failure requiring mechanical ventilation and high dose inotropes with persistent lactate >20. He was cannulated to VA ECMO and tandem continuous renal replacement therapy (CRRT) with single pass albumin dialysis (SPAD) and plasma exchange (PLEX) therapies. He required high dose inotropes on ECMO and had persistently elevated lactate despite maximal medical therapy. Limited imaging studies suggested cirrhotic liver and possible intestinal pneumatosis. Due to evidence of fulminant ALF and potential for a reversible process, he …
Improving Nutritional Delivery To Pediatric Patients On Continuous Renal Replacement Therapy, Jennifer Ruiz-Boada, Sarah Brunner, Tara Benton, Vimal Chadha
Improving Nutritional Delivery To Pediatric Patients On Continuous Renal Replacement Therapy, Jennifer Ruiz-Boada, Sarah Brunner, Tara Benton, Vimal Chadha
Presentations
INTRODUCTION: Continuous renal replacement therapy (CRRT) is used in critically ill children with acute renal failure. CRRT can lead to malnutrition by removing essential proteins and micronutrients. Malnutrition is associated with worse outcomes, including increased length of stay and mortality. CRRT guidelines suggest the importance of early nutrition and ensuring high protein intake. After evaluating our CRRT patients, we found sub-optimal adherence to the guidelines. This Quality Improvement project aimed to increase the percentage of patients achieving 75% of their goal protein and caloric intake by day 5 of CRRT initiation by 15% by August 2023. METHODS: A multidisciplinary group …
Position Specific Injury Patterns In Male Developmental Academy Soccer Players, Andrew Donaldson, Catharine Kral, Shannon Margherio, Mckeenna Noe, Brian S. Harvey
Position Specific Injury Patterns In Male Developmental Academy Soccer Players, Andrew Donaldson, Catharine Kral, Shannon Margherio, Mckeenna Noe, Brian S. Harvey
Presentations
Background: Despite the availability of high-quality evidence describing injury patterns in European professional soccer players, there is a paucity of data regarding American athletes. This disparity is accentuated for elite youth athletes. Our study identifies position-specific injury patterns occurring in elite youth male soccer players. Hypothesis: We hypothesize that there are injury types, locations, and specific injuries that occur most frequently in elite youth soccer players and that certain positions have a higher frequency of these injuries than others. Methods: Data from a retrospective review of the IRB-approved Male Academy Soccer Registry from August 1, 2019 through June 30, 2022 …