Pediatrics Commons^™

Two Adolescent Idiopathic Scoliosis (Ais) Cases, Two Surgeons, One Operating Room, One Day. Faster And Safer Than One Case In A Day., Jonathan Warren, Robert C. Link, Sean Bonanni, John T. Anderson, Richard M. Schwend

Research Days

Background: To lessen surgical times for AIS patients undergoing posterior spinal instrumentation and fusion (PSIF), our department developed a quality improvement initiative where two AIS cases were completed in one day by a specialized team with two surgeons operating together in the same operating room (OR).

Objectives/Goal: Our purpose is to describe the results of this initiative and compare operative times and outcomes to single cases completed by a single surgeon during the same period.

Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution (Group …

A Comparison Of Large Tbsa Scald Versus Flame Burns In Young Children, Ashley Daniel

Research Days

Background: It is generally accepted that of children with the same total body surface area of burns, those with flame burns seem to have longer lengths of stay and more complications than those with scald burns. Anecdotally we have seen the opposite to be true. Among a consortium of five US pediatric burn centers participating in the Pediatric Injury Quality Improvement Collaborative (PIQIC), young children with scald burns seem to experience disproportionately more frequent and severe complications compared to their older counterparts and compared to patients of a similar age with flame burns.

Objectives/Goal: In this multi-institutional study, we compared …

Relationship Between Rurality And Access To Care For Families Of Hospitalized Children, Zoetta L. Mcloughlin Md

Research Days

Background: At Children’s Mercy Hospital, greater than 1 in 5 hospitalized children are from rural areas. Rural families often travel long distances for hospitalization at free-standing children’s hospitals, a median of 70 miles according to recent work. Rural families are more likely than non-rural families to experience financial insecurity, and these baseline hardships may be intensified during hospitalization due to out-of-pocket costs, lost work, inability to meet family needs, and removal from social support. However, little is known about the differences in healthcare access and resulting burdens between rural and non-rural families.

Objectives/Goal: To describe differences in demographics, health care …

Rural And Urban Caregiver Experiences Of Financial Strain And Food Insecurity During Pediatric Hospitalizations, Rachel E. Granberg

Research Days

Background: Stress is common among caregivers of hospitalized children. In addition to stress related to their child’s illness, caregivers experience stress related to financial strain and food insecurity during their child’s hospitalization. The burden of financial strain and food insecurity related to pediatric hospitalizations may vary between rural and urban populations.

Objectives/Goal: To identify financial strain and food insecurity experienced by caregivers of hospitalized children and to describe differences between rural and urban populations.

Methods/Design: A prospective cross-sectional survey enrolled a random sample of caregivers of hospitalized children between 8/31/2021 and 12/2/2022 at a single children’s hospital. Demographic information was …

Female Authorship Concordance In Academic Pediatrics, Roxana Guggenmous, Jessica L. Bettenhausen, Jessica L. Markham

Research Days

Background: Gender disparities are well described in medicine and academia. Despite a catalyzed movement towards gender equity, female physician-scientists remain at risk for experiencing biases in hiring practices, compensation, promotion, appointment to leadership positions, and achievement of extramural funding through the National Institutes of Health. In pediatrics, the female workforce has grown consistently over time, with female physicians comprising 72.3% of the workforce as of 2021, yet prior work suggests that this growth is not fully reflected in academic publications. Achieving gender parity in academic publication may help reduce gender-based disparities impacting career advancement. Therefore, we sought to describe the …

A Novel Therapy For Refractory Cbfa2t3::Glis2-Associated Amkl Using Stro-002 And Plerixafor, Amy Johnson Md, Mba, Alan S. Gamis, Arturo Molina, Soheil Meshinchi, Karen Lewing

Research Days

Background: CBFA2T3::GLIS2-associated AML (CBF/GLIS AML) is an aggressive form of AML often associated with AMKL and recognized by its unique RAM phenotype by flow. It has a very poor prognosis, frequently refractory to standard of care regimens, with extreme marrow localization of leukemic blasts likely mediated by high CXCR4 (CD184) expression. The CBFA2T3::GLIS2 fusion gene is the most common oncogenic transcript in pediatric AMKL and universally results in high expression of FOLR1 surface antigen. STRO-002, an antibody drug conjugate targeting FOLR1, is currently in Phase I clinical trials for adults with refractory ovarian and endometrial malignancies A summary of 17 …

Understanding Home Visitor Attendance At Well Child Checks: A Mixed Methods Study, Rachel Segal, Sommer Rose, Marcia Dutcher, Tyler Myroniuk, Mary Moffatt, James Anderst

Research Days

Background: Early childhood home visiting programs have variable outcomes on child health across models and studies. Given this variability, novel approaches are needed to foster consistent positive outcomes. One approach is attendance of a home visitor (HV) at medical provider well child checks (WCCs) to provide a stronger link between home visiting and the medical home. This process may be assessed in an exploratory study evaluating the qualitative perceptions and initial quantitative effects of the intervention.

Objectives/Goal: Qualitatively explore perspectives of HVs attending WCCs and quantitatively evaluate effects of the practice on (1) family compliance with American Academy of Pediatrics …

Pediatric Educational Outreach To A Community Based Emergency Department: Clinical Management Of The Febrile Infant, Jess Parker, Frances Turcotte Benedict, Emily Hillman, Ryan C. Jacobsen, Ashley K. Sherman, Arjun Sarin

Research Days

Background: Multiple studies have shown variability in the approach to treatment of febrile infants ≤ 60 days of age in community emergency departments (EDs), and the American Academy of Pediatrics (AAP) recently published new guidelines on management of febrile infants. Therefore, an opportunity exists to provide evidence-based recommendations for the care of this patient population to providers in community EDs.

Objectives/Goal: To assess 1) alignment of community ED provider practices with an AAPinformed Clinical practice guideline (CPG) for management of febrile infants ≤ 60 days of age. 2) change in comfort level and degree of alignment after targeted education.

Methods/Design: …

Inpatient Insulin Management For Severe Hypertriglyceridemia In Pediatrics, Erica Wee, Ryan Mcdonough, Matthew M. Feldt

Research Days

Background: Severe hypertriglyceridemia (SHTG) is defined as triglyceride (TG) >= 1000 mg/dL and increases the risk of developing acute pancreatitis. Insulin activates lipoprotein lipase which accelerates chylomicron degradation leading to a rapid decrease in TG levels. There is a paucity of pediatric standard of care for insulin use to treat SHTG.

Objectives/Goal: Our objective was to develop a protocol to standardize SHTG management using insulin infusion and decrease the duration of SHTG resolution while preventing hypoglycemia.

Methods/Design: Endocrinology, Evidence-Based Practice, Hospital Medicine, Critical Care, Gastroenterology, Pharmacy, and Nursing met to develop the protocol. Pediatric and adult literature were reviewed, and …

Socioeconomic Factors And Picu Interventions In High Mortality Risk Asthmatics, Hanh Ho, Paul N. Bauer, Jade B. Tam-Williams

Research Days

Background: Asthma mortality rates are overall lower in children, but studies estimate 5-10% of asthmatics have refractory mortality prone asthma. Asthmatics with repeat pediatric intensive care unit (PICU) admissions are believed to be at high mortality risk with increased health care utilization and socio-economic challenges.

Objectives/Goal: We aim to identify patients with repeat PICU admissions for status asthmaticus and characterize the levels of interventions and socio-economic status.

Methods: A retrospective chart review was done on patients with the following inclusion criteria: age 0- 18, PICU admission between January 2010 to December 2015, and a diagnosis of status asthmaticus on admission. …

Supporting Families Impacted By Adverse Childhood Experiences (Aces), Jennifer Paumen, Laura Plencner, Jacqueline Kitchen

Research Days

Background: Adverse childhood experiences (ACEs) impact a majority of individuals, with approximately two-thirds of adults having experienced 1 or more ACE.1 The health consequences of ACEs are significant, including cardiovascular disease, cancer, autoimmune diseases, and mental illnesses.1 These health impacts can even start as early as childhood, leading to an increased risk of learning and behavioral concerns.2,3 Recent evidence has also identified the impact that parental ACEs may have on parenting and child development,4,5,6 which in turn may lead to an intergenerational transmission of ACEs.4,7 As a nurturing caregiver relationship is key for buffering adversity,2,8 it is imperative to address …

Pediatric Serum-Like Sickness: A Multicenter Analysis, Maya Gibson, Sarah Suppes, Jared Lovins, Emma Monique, Keith Feldman, Jennifer Goldman

Research Days

Background: Serum sickness-like reaction (SSLR) is a type III immune hypersensitivity reaction that presents 5-21 days following exposure to a medication. SSLR has nonspecific symptoms including fever, rash, and joint involvement. There are no standardized diagnostic criteria or treatment for SSLR, making this a challenging diagnosis.

Objectives/Goal: Our objective was to describe pediatric SSLR clinical manifestations, medical encounter types, and treatment strategies.

Methods/Design: A retrospective chart review across 2 freestanding children’s hospitals was used to identify patients 0-21 years of age diagnosed with SSLR by ICD-9/10 codes [T80.69XA, 999.59], SNOMED codes [1782626019, 3293325014], or pharmacovigilance review in the emergency department …

Increasing Incentive Spirometry Use In Patients With Sickle Cell Disease: Longer Follow-Up Of Pdsa Cycle 1, Alexandra Prosser, Thomas Cochran

Research Days

Problem Statement/Question: Acute chest syndrome (ACS) is one of the leading causes of morbidity and mortality in patients with sickle cell disease. Patients are at higher risk for this complication during hospital admission due to limited mobility leading to decreased lung inflation. The National Heart, Lung, and Blood Institute (NHLBI) recommends providing ten breaths of incentive spirometry (IS) every two hours while awake for patients admitted to the hospital with sickle cell disease to help prevent development of acute chest syndrome. Without this intervention, patients are more likely to develop ACS requiring increased level of care, prolonged hospital stays, and …

Influencing Influenza Immunization: Qi Project In A Pediatric Resident Continuity Clinic, Brittany Moore

Research Days

Problem Statement/Question: There have been a multitude of approaches to vaccine hesitancy in regard to childhood vaccinations. In light of the COVID-19 pandemic there was a noticeable decline in influenza vaccination among children aged 6 months to 18 years. The influenza vaccination rate in the pediatric resident continuity clinic at Children’s Mercy Hospital was below the national average for pediatric patients.

Background/Project Intent (Aim Statement): The aim of this study is to increase the percentage of patients aged 6 month and older currently enrolled in ROYAL clinic receiving at least one influenza vaccine from 38.6% to 55% by January 1, …

Increasing Utilization Of Gestational Age Based Table For Initial Intubation In A Level Iv Neonatal Intensive Care Unit, Maribel Martinez, Dianne Lee, Christopher R. Nitkin

Research Days

Problem Statement/Question: Most providers in our unit are not using the NRP recommended method to determine the initial ETT insertion depth in neonates.

Background/Project Intent (Aim Statement): Endotracheal tube (ETT) depth in neonates is of critical importance due to significant adverse events when malpositioned. While randomized trials comparing different methods have not shown superiority of any particular method, the weight-based method (weight (kg) +6) has been found to be highly inaccurate in extremely low birth weight neonates. Furthermore, the Neonatal Resuscitation Program (NRP) recommends using gestational age (GA)-based table (Kempley ST, et al, Resuscitation 2008) or nasal-tragal length for initial …

Converting Paper Faxes To Electronic Faxes To Improve Patient Care, Decrease Paper Burden, And Improve Staff And Provider Satisfaction: A Quality Improvement Project, Stephanie Green, Amanda Lindenberg

Research Days

Problem Statement/Question: Reliance on provider and administrative staff to be physically present at Adele Hall creates delays in delivery of completed documentation. Delays of up to 7-14 days are possible. Delays in completion result in outside offices resending (wasted duplication of work) requests and delay downstream delivery of equipment/services, ultimately negatively impacting patient care. Over a 2-week period in November 2022, it took at average of 6.08 days for time to completion of requests. Over a 4-week period in August 2022, divisional outgoing faxes in response to requests averaged 79.5 per week. In addition, reliance on hardcopies of requests increases …

Improving Frequency Of Peer Review Of Abnormal Genital Exam Findings In Patients Undergoing Sexual Abuse Evaluation, Lyndsey Hultman, Julia G. Harris, Terra N. Frazier, Jennifer B. Hansen

Research Days

Problem Statement/Question: Child Advocacy Centers (CACs) coordinate child abuse MDTs, and 2023 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.” Scheduled Case Review occurs among Children’s Mercy child abuse pediatricians (CAPs), but current practice is to review cases only upon CAP request.

Background/Project Intent (Aim Statement): Appropriate interpretation of sexual abuse exam findings is crucial for accurate diagnosis and provision of medical information to multidisciplinary child protection teams (MDTs). Medical …

Unique Endoscopic Retrieval Of A Large Rectal Foreign Body, Laurie Mccann, Jose Cocjin

Research Days

Introduction: Large rectal foreign bodies are usually difficult to extract, usually requiring operative management.

Case: A 14-year-old male presented to the ER for a rectal foreign body. Earlier in the day, he had rectal itching and inflammation. He used a cylindrical reusable ice stick (for water bottles) for topical relief, which did not work, so he placed the tube in his rectum, then he was unable to retrieve it and sought medical help. Physical exam was significant for lower abdominal pain and palpable mass just below his umbilicus, which was painful to palpate. CT abdomen/pelvis showed a large foreign body …

Improving Imaging Practices Following Arterial Switch Operation, Mollie Walton, Nir Atlas, Sanket Shah

Research Days

Problem Statement/Question: Long-term risk in post-operative cardiac patients exists, and morbidity may be avoided with advanced imaging surveillance.

Background/Project Intent (Aim Statement): The Appropriate Use Criteria (AUC) for Multimodality Imaging During Follow-Up Care of Patients with Congenital Heart Disease (CHD) was published in 2020 by the American College of Cardiology Foundation. This includes a subsection for D-Looped Transposition of the Great Arteries (D-Loop TGA). The arterial switch operation (ASO) is the preferred method for surgical repair of D-Loop TGA. Appropriate and timely use of advanced imaging is essential in optimizing long-term postsurgical outcomes. The objective of this quality improvement (QI) …

Improving Fluid Management Of Extreme Premature Infants By Providing A Restrictive Fluid Management Algorithm In The Nicu, Jacob S. Ward, Dena Hubbard, Nicholas Clark

Research Days

Problem Statement/Question: At our institution we found wide variability in and a lack of an evidence-based standard for fluid management in premature infants.

Background/Project Intent (Aim Statement): Excessive fluid intake in premature infants during the first week of life increases the risk of adverse events and overall mortality. Fluid restriction is recommended to help decrease morbidity and mortality in this patient population. We aimed to improve the fluid management of premature infants born < 29 weeks gestation admitted to our intensive care nursery (ICN) by implementing a fluid restriction protocol with the goal of >70% compliance over a 16-month period.

Methods (include PDSA cycles): Institution of daily weights started at beginning of baseline period. In April of 2021, we implemented a …