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https://www.readbyqxmd.com/read/29787555/implementation-of-a-ct-scan-practice-guideline-for-pediatric-trauma-patients-reduces-unnecessary-scans-without-impacting-outcomes
#1
Patrick R McGrew, Paul J Chestovich, Jay D Fisher, Deborah A Kuhls, Douglas R Fraser, Purvi P Patel, Chad W Katona, Syed Saquib, John J Fildes
INTRODUCTION: Computed Tomography (CT) scans are useful in the evaluation of trauma patients, but are costly and pose risks from ionizing radiation in children. Recent literature has demonstrated the utility of CT scan guidelines in the management of pediatric trauma. This study objective is to review our treatment of pediatric blunt trauma patients and evaluate CT utilization before and after CT-guideline implementation. METHODS: Our Pediatric Level 2 Trauma Center (TC) implemented a CT scan practice guideline for pediatric trauma patients in March 2014...
May 4, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29782625/use-of-rituximab-and-risk-of-re-hospitalization-for-children-with-neuromyelitis-optica-spectrum-disorder
#2
Sabrina Gmuca, Rui Xiao, Pamela F Weiss, Amy T Waldman, Jeffrey S Gerber
Background: Treatment algorithms for neuromyelitis optica spectrum disorder (NMOSD) vary, and sparse data exist regarding the impact of initial treatments on disease course. We aimed to determine whether administration of rituximab during first hospitalization reduces 1-year readmission rates. Methods: We conducted a retrospective cohort study of subjects with NMOSD using the Pediatric Health Information System database from 2005-2015. Subjects were ages 1 to 21 years who received glucocorticoids and an ICD-9-CM code indicating neuromyelitis optica (NMO) during first hospitalization...
April 2018: Multiple Sclerosis and Demyelinating Disorders
https://www.readbyqxmd.com/read/29753542/children-with-chronic-disease-bear-the-highest-burden-of-pediatric-sepsis
#3
Andrew J Prout, Victor B Talisa, Joseph A Carcillo, Florian B Mayr, Derek C Angus, Christopher W Seymour, Chung-Chou H Chang, Sachin Yende
OBJECTIVE: To describe the contemporary epidemiology of pediatric sepsis in children with chronic disease, and the contribution of chronic diseases to mortality. We examined the incidence and hospital mortality of pediatric sepsis in a nationally representative sample and described the contribution of chronic diseases to hospital mortality. STUDY DESIGN: We analyzed the 2013 Nationwide Readmissions Database using a retrospective cohort design. We included non-neonatal patients <19 years of age hospitalized with sepsis...
May 9, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29752289/interventions-to-reduce-over-utilized-tests-and-treatments-in-bronchiolitis
#4
Amy Tyler, Paige Krack, Leigh Anne Bakel, Kimberly O'Hara, Douglas Scudamore, Irina Topoz, Julia Freeman, Angela Moss, Renee Allen, Angela Swanson, Lalit Bajaj
OBJECTIVES: The American Academy of Pediatrics published bronchiolitis clinical practice guidelines in 2014 recommending against the routine use of bronchodilators, chest radiographs, or respiratory viral testing in children with a clinical diagnosis of bronchiolitis. Our aim in this project was to align care with the American Academy of Pediatrics clinical practice guidelines by decreasing the overuse of these interventions. METHODS: This study included patients who were admitted to a non-ICU setting with a primary or secondary diagnosis of bronchiolitis...
May 11, 2018: Pediatrics
https://www.readbyqxmd.com/read/29743805/outcomes-after-endoscopic-dilation-of-laryngotracheal-stenosis-an-analysis-of-acs-nsqip
#5
Avni Bavishi, Emily Boss, Rahul K Shah, Jennifer Lavin
Importance: Endoscopic management of pediatric subglottic stenosis (SGS) is common, however no multi-institutional studies have assessed its perioperative outcomes. The American College of Surgeon's National Surgical Quality Improvement Program - Pediatric (ACS-NSQIP-P) represents a source of such data. Design: Current procedural terminology (CPT) codes were queried for endoscopic or open airway reconstruction in the ACS-NSQIP-P Public Use File (PUF). Demographics and 30-day events were abstracted to compare open to endoscopic techniques and to assess for risk factors for varied outcomes after endoscopic dilation...
March 2018: Journal of Clinical Outcomes Management: JCOM
https://www.readbyqxmd.com/read/29728170/pediatric-lateral-neck-infections-computed-tomography-vs-ultrasound-on-initial-evaluation
#6
Nicholas A Quinn, Jared A Olson, Jeremy D Meier, Hank Baskin, Jeff E Schunk, Emily A Thorell, Laura N Hodo
OBJECTIVE: Review the evaluation of children with a deep lateral neck infection and define the impact of initial imaging modality on outcomes and costs. METHOD: Case series, pediatric patients <18 years of age admitted to a tertiary care hospital with lateral neck infection between 01/01/14-05/31/16 as identified by ICD-9 and ICD-10 codes: 289.3 (lymphadenitis, unspecified), 682.1 (cellulitis and abscess of neck), 683 (acute lymphadenitis), I88.9 (nonspecific lymphadenitis, unspecified), L02...
June 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29727410/improved-diagnosis-and-treatment-of-bone-and-joint-infections-using-an-evidence-based-treatment-guideline
#7
Rachel D Quick, John Williams, Marisol Fernandez, Hilton Gottschalk, Peter Cosgrove, Kyle Kahlden, Kathryn Merkel, Lynn Thoreson, Patrick Boswell, Sarmistha B Hauger
BACKGROUND: Our institution created a multidisciplinary guideline for treatment of acute hematogenous osteomyelitis (AHO) and septic arthritis (SA) in response to updates in evidence-based literature in the field and existing provider variability in treatment. This guideline aims to improve the care of these patients by standardizing diagnosis and treatment and incorporating up to date evidence-based research into practice. The primary objective of this study is to compare cases before versus after the implementation of the guideline to determine concrete effects the guideline has had in the care of patients with AHO and SA...
May 2, 2018: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/29727261/virtual-telemedicine-visits-in-pediatric-home-parenteral-nutrition-patients-a-quality-improvement-initiative
#8
Bram P Raphael, Caitlin Schumann, Sara Garrity-Gentille, Jennifer McClelland, Carolyn Rosa, Christina Tascione, Mary Gallotto, Melissa Takvorian-Bené, Alexandra N Carey, Patrick McCarthy, Christopher Duggan, Al Ozonoff
BACKGROUND: Despite being less costly than prolonged hospitalization, home parenteral nutrition (HPN) is associated with high rates of post-discharge complications, including frequent readmissions and central line-associated bloodstream infections (CLABSIs). Telemedicine has been associated with improved outcomes and reduced healthcare utilization in other high-risk populations, but no studies to date have supported effectiveness of telemedicine in pediatric HPN. METHODS: We prospectively collected data on pediatric patients managed at a single HPN program who participated in postdischarge telemedicine visits from March 1, 2014 to March 30, 2016...
May 4, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/29720908/implementation-and-impact-of-an-antimicrobial-stewardship-program-at-a-non-freestanding-children-s-hospital
#9
J Michael Klatte, Kathleen Kopcza, Alexander Knee, Evan R Horton, Erica Housman, Donna J Fisher
OBJECTIVES: Pediatric Antimicrobial Stewardship Programs (ASP) have been associated with improvements in antibiotic utilization and patient outcomes; however, ASP studies originating from non-freestanding children's hospitals are lacking. In this study, we present the implementation and impact of a multidisciplinary ASP that employs a collaborative physician and pharmacist driven thrice-weekly prospective audit-with-feedback approach at a non-freestanding children's hospital. METHODS: Implementation was assessed via descriptive design...
March 2018: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/29701559/complications-following-lengthening-of-spinal-growing-implants-is-postoperative-admission-necessary
#10
K Aaron Shaw, Nicholas D Fletcher, Dennis P Devito, Joshua S Murphy
OBJECTIVE The aim of this study was to evaluate the effect of postoperative admission status on 30-day perioperative complications in patients with growing spinal instrumentation undergoing surgical lengthening. METHODS This retrospective case-control study of records from the 2014-2015 National Surgical Quality Improvement Program-Pediatric database was performed to identify surgical lengthening procedures of spinal implants in patients with growing instrumentation by Current Procedural Terminology code. The 30-day postoperative complications were classified according to the Clavien-Dindo system...
April 27, 2018: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/29697617/outpatient-versus-inpatient-primary-cleft-lip-and-palate-surgery-analysis-of-early-complications
#11
Rami S Kantar, Michael J Cammarata, William J Rifkin, Natalie M Plana, J Rodrigo Diaz-Siso, Roberto L Flores
BACKGROUND: Fiscal constraints are driving shorter hospital lengths of stay. Outpatient primary cleft lip surgery has been shown to be safe, but outpatient primary cleft palate surgery remains controversial. This study evaluates outcomes following outpatient versus inpatient primary cleft lip and palate surgery. METHODS: The American College of Surgeons National Surgical Quality Improvement Program Pediatric database was used to identify patients undergoing primary cleft lip and palate surgery between 2012 and 2015...
May 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29694459/characterizing-hospitalizations-for-pediatric-concussion-and-trends-in-care
#12
Tara Rhine, Terri Byczkowski, Mekibib Altaye, Shari L Wade, Lynn Babcock
BACKGROUND: Children hospitalized for concussion may be at a higher risk for persistent symptoms, but little is known about this subset of children. OBJECTIVE: Delineate a cohort of children admitted for concussion, describe care practices received, examine factors associated with prolonged length of stay (LOS) or emergency department (ED) readmission, and investigate changes in care over time. DESIGN, SETTING: Retrospective analysis of data submitted by 40 pediatric hospitals to the Pediatric Health Information System...
April 25, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29680415/home-antibiotics-at-discharge-for-pediatric-complicated-appendicitis-friend-or-foe
#13
Kathryn Tinsley Anderson, Marisa A Bartz-Kurycki, Akemi L Kawaguchi, Mary T Austin, Galit Holzmann-Pazgal, Lillian S Kao, Kevin P Lally, Kuojen Tsao
BACKGROUND: The role of home discharge antibiotics in children after perforated appendicitis is unclear. This study evaluates the outcomes of complicated appendicitis patients being discharged with or without home antibiotics after initial surgery and in-patient treatment. STUDY DESIGN: The 2015 and 2016 National Surgical Quality Improvement-Pediatric (NSQIP-P) database was queried for patients <18 years of age with complicated appendicitis. Home antibiotics (HA) were prescribed or not (No Home Antibiotics- NHA)...
April 19, 2018: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29673611/the-cost-effectiveness-and-utility-of-a-quick-mri-for-the-evaluation-of-intra-abdominal-abscess-after-acute-appendicitis-in-the-pediatric-patient-population
#14
Tiffany J Zens, Andrew P Rogers, Erica L Riedesel, Charles M Leys, Daniel J Ostlie, Michael A Woods, Kara G Gill
INTRODUCTION: Contrast-enhanced CT remains the first-line imaging for evaluating postoperative abscess (POA) after appendicitis. Given concerns of ionizing radiation use in children, we began utilizing quick MRI to evaluate POA and summarize our findings in this study. MATERIALS AND METHODS: Children imaged with quick MRI from 2015 to 2017 were compared to children evaluated with CT from 2012 to 2014 using an age and weight matched case-control model. Radiation exposure, size and number of abscesses, length of exam, drain placement, and patient outcomes were compared...
March 6, 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29667699/lean-perspectives-a-case-for-implementing-parent-child-relational-problem-screening
#15
Bryson C Okeoma
The purpose of the current study was to make a case for instituting parent-child relational problem (PCRP) screening as a standard of care in pediatric inpatient psychiatric units due to increasing evidence that PCRP may be an underreported problem that affects more adolescents than currently realized. Adolescents who are admitted to the hospital for mood exacerbation, suicidal ideation, self-harm behavior, or behavioral escalation may improve and be discharged. However, these adolescents often are readmitted, which may be associated with parent-child relational factors...
April 17, 2018: Journal of Psychosocial Nursing and Mental Health Services
https://www.readbyqxmd.com/read/29661575/outcomes-of-laparoscopic-resection-of-meckel-s-diverticulum-are-equivalent-to-open-laparotomy
#16
Brian Ezekian, Harold J Leraas, Brian R Englum, Brian F Gilmore, Christopher Reed, Tamara N Fitzgerald, Henry E Rice, Elisabeth T Tracy
PURPOSE: Meckel's diverticulum (MD) is a common congenital anomaly caused by failure of involution of the omphalomesenteric duct. Enthusiasm for minimally invasive surgery (MIS) in children has burgeoned as technologies have advanced, but the outcomes of laparoscopic resection in comparison to open laparotomy for MD remain poorly defined. We queried a large national database to compare current practice patterns and clinical outcomes between surgical approaches for MD in the pediatric population...
March 15, 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29656703/the-ethics-of-concurrent-care-for-children-a-social-justice-perspective
#17
Kim Mooney-Doyle, Jessica Keim-Malpass, Lisa C Lindley
Recent estimates indicate that over 40,000 children die annually in the United States and a majority have life-limiting conditions. Children at end of life require extensive healthcare resources, including multiple hospital readmissions and emergency room visits. Yet, many children still suffer from symptoms at end of life-including fatigue, pain, dyspnea, and anxiety-with less than 10% of these children utilizing hospice care services. A critical barrier to pediatric hospice use was the original federal regulations associated with the hospice care that required a diagnosis of 6 months to live and the discontinuation of all curative treatments...
January 1, 2018: Nursing Ethics
https://www.readbyqxmd.com/read/29629980/development-of-an-enhanced-recovery-protocol-for-children-undergoing-gastrointestinal-surgery
#18
Mehul V Raval, Kurt F Heiss
PURPOSE OF REVIEW: Enhanced recovery protocols (ERPs) have been adopted for a variety of adult surgical conditions and resulted in markedly improved outcomes, including decreased length of stays, complications, costs, and narcotic utilization. In this review, we describe the development and implementation of an ERP for children undergoing gastrointestinal surgery. RECENT FINDINGS: Existing ERP components from adult and pediatric surgical populations were reviewed and modified through an iterative process that included literature review, a national survey of practicing pediatric surgeons, and appropriateness assessment by a multidisciplinary expert panel...
June 2018: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29627174/short-term-outcomes-in-children-undergoing-restorative-proctocolectomy-with-ileal-pouch-anal-anastomosis
#19
Katerina Dukleska, Loren Berman, Allison A Aka, Charles D Vinocur, Erin A Teeple
INTRODUCTION: Patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC) commonly undergo restorative proctocolectomy with ileal-pouch anal anastomosis (RP-IPAA). We sought to describe patient characteristics and postoperative outcomes in this patient population. METHODS: Using the National Surgical Quality Improvement Program-Pediatric Participant Use Files from 2012 to 2015, children who were 6-18years old who underwent RP-IPAA for FAP or UC were identified...
March 7, 2018: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29626010/comparison-of-empiric-antibiotics-for-acute-osteomyelitis-in-children
#20
Sarah McBride, Cary Thurm, Ramikan Gouripeddi, Bryan Stone, Phil Jaggard, Samir S Shah, Joel S Tieder, Ryan Butcher, Jason Weiser, Matt Hall, Ron Keren, Christopher P Landrigan
OBJECTIVES: Broad-spectrum antibiotics are commonly used for the empiric treatment of acute hematogenous osteomyelitis and often target methicillin-resistant Staphylococcus aureus (MRSA) with medication-associated risk and unknown treatment benefit. We aimed to compare clinical outcomes among patients with osteomyelitis who did and did not receive initial antibiotics used to target MRSA. METHODS: A retrospective cohort study of 974 hospitalized children 2 to 18 years old using the Pediatric Health Information System database, augmented with clinical data...
April 6, 2018: Hospital Pediatrics
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