152 results on '"Derek J. Williams"'
Search Results
2. Natural Language Processing and Machine Learning to Enable Clinical Decision Support for Treatment of Pediatric Pneumonia.
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Joshua C. Smith, Ashley Spann, Allison B. McCoy, Jakobi A. Johnson, Donald H. Arnold, Derek J. Williams, and Asli Weitkamp
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- 2020
3. Caregiver and Clinician Perspectives on Discharge Medication Counseling: A Qualitative Study
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Alison R. Carroll, David Schlundt, Kemberlee Bonnet, Amanda S. Mixon, and Derek J. Williams
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Pediatrics, Perinatology and Child Health ,General Medicine ,Pediatrics - Abstract
OBJECTIVES Children are at increased risk for medication errors and the transition from hospital-to-home is a vulnerable time for errors to occur. This study aimed to explore the perspectives of multidisciplinary clinicians and caregivers regarding discharge medication counseling and to develop a conceptual model to inform intervention efforts to reduce discharge medication dosing errors. METHODS We conducted semistructured interviews with clinicians and caregivers of children RESULTS We conducted focus groups and individual interviews with 17 caregivers and 16 clinicians. Using the Donabedian structure-process-outcomes model of quality evaluation, domains and subthemes included: (1) infrastructure of healthcare delivery, including supplies for counseling, content and organization of discharge instructions, clinician training and education, roles and responsibilities of team members, and hospital pharmacy delivery and counseling program; (2) processes of healthcare delivery, including medication reconciliation, counseling content, counseling techniques, and language barriers and health literacy; and (3) measurable outcomes, including medication dosing accuracy and caregiver understanding and adherence to discharge instructions. CONCLUSIONS The conceptual model resulting from this analysis can be applied to the development and evaluation of interventions to reduce discharge medication dosing errors following a hospitalization. Interventions should use a health literacy universal precautions approach—written materials with plain language and pictures and verbal counseling with teach-back and show-back.
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- 2023
4. Parental Perceptions of Penicillin Allergy Risk Stratification and Delabeling
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James W. Antoon, Carlos G. Grijalva, Alison R. Carroll, Jakobi Johnson, Justine Stassun, Kemberlee Bonnet, David G. Schlundt, and Derek J. Williams
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Pediatrics, Perinatology and Child Health ,General Medicine ,Pediatrics - Abstract
BACKGROUND Penicillin (PCN) allergy labels are widely recognized to be highly inaccurate. Little is known about parental perceptions of the PCN allergy evaluation and removal process, especially in the hospital setting. METHODS Focus groups were held with parents of children and adolescents with a PCN allergy label discharged from a large academic children’s hospital between January 1, 2019, and April 15, 2020. The open-ended, semistructured moderator guide included questions about PCN allergy testing and evaluation, accuracy of the PCN allergy diagnosis, amoxicillin oral challenges, delabeling process, and preferred setting for PCN allergy delabeling evaluation (outpatient clinic, hospital, etc). Study investigators coded the transcripts and identified underlying themes using inductive and deductive thematic analysis. RESULTS A total of 21 parents and 2 adolescents participated across 4 focus groups. We developed a theoretical framework depicting key elements of parents’ and adolescents’ experiences with PCN allergies, consisting of 4 major interconnected themes: (1) family context; (2) the invitation to delabel; (3) decision context; and (4) the PCN delabeling outcome. PCN allergies remained a concern for families even if their children passed an oral challenge. Some parents preferred testing to be performed in the hospital and felt this was a safer location for the procedure. CONCLUSIONS Parents are amenable to hospital based PCN allergy evaluation and delabeling. Further studies should incorporate parental and patient preferences to implement safe and effective PCN allergy delabeling processes in the hospital setting.
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- 2023
5. Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals
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Ryan M. Wolf, Matthew Hall, Derek J. Williams, Alison R. Carroll, James W. Antoon, Charlotte M. Brown, Alison Herndon, Heather Kreth, Carrie Lind, Kelsey A. B. Gastineau, Katherine Spencer, My‐Linh Ngo, Sarah Hart, Lindsay White, and David P. Johnson
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Leadership and Management ,Health Policy ,Fundamentals and skills ,General Medicine ,Assessment and Diagnosis ,Care Planning - Abstract
Children in mental health crises are increasingly admitted to children's hospitals awaiting inpatient psychiatric placement. During hospitalization, patients may exhibit acute agitation prompting pharmacologic restraint use.To determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals.We examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Hospital rates of parenteral pharmacologic restraint use per 1000 mental health bed days were determined and compared after adjusting for patient-level and demographic factors. Cluster analysis (k-means) was used to group hospitals based on overall restraint use (rate quartiles) and drug class. Hospital-level factors for pharmacologic restraint use were compared.Of 29,834 included encounters, 3747 (12.6%) had pharmacologic restraint use. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175 (standard deviation: 72). Cluster analysis revealed three hospitals were high utilizers of all drug classes. No significant differences in pharmacologic restraint use were found in the hospital-level analysis.Children's hospitals demonstrate wide variation in pharmacologic restraint rates for mental health hospitalizations, with a 10-fold difference in adjusted rates between highest and lowest utilizers, and high overall utilizers order medications across all drug classes.
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- 2022
6. Hospital-Level Neighborhood Opportunity and Rehospitalization for Common Diagnoses at US Children's Hospitals
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Andrew G. Yu, Matt Hall, Ladan Agharokh, Benjamin C. Lee, Isabella Zaniletti, Karen M. Wilson, and Derek J. Williams
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Residence Characteristics ,Pediatrics, Perinatology and Child Health ,Humans ,Family ,Child ,Hospitals, Pediatric ,Asthma - Abstract
Neighborhood conditions influence child health outcomes, but data examining association between local factors and hospital utilization are lacking. We determined if hospitals' mix of patients by neighborhood opportunity correlates with rehospitalization for common diagnoses at US children's hospitals.We analyzed all discharges in 2018 for children ≤18 years at 47 children's hospitals for 14 common diagnoses. The exposure was hospital-level mean neighborhood opportunity - measured by Child Opportunity Index (COI) - for each diagnosis. The outcome was same-cause rehospitalization within 365 days. We measured association via Pearson correlation coefficient. For diagnoses with significant associations, we also examined shorter rehospitalization time windows and compared unadjusted and COI-adjusted rehospitalization rates.There were 256,871 discharges included. Hospital-level COI ranged from 17th to 70th percentile nationally. Hospitals serving lower COI neighborhoods had more frequent rehospitalization for asthma (ρ -0.34 [95% confidence interval -0.57, -0.06]) and diabetes (ρ -0.33 [-0.56, -0.04]), but fewer primary mental health rehospitalizations (ρ 0.47 [0.21, 0.67]). There was no association for 11 other diagnoses. Secondary timepoint analysis revealed increasing correlation over time, with differences by diagnosis. Adjustment for hospital-level COI resulted in 26%, 32%, and 45% of hospitals changing1 decile in rehospitalization rank order for diabetes, asthma, and mental health diagnoses, respectively.Children's hospitals vary widely in their mix of neighborhoods served. Asthma, diabetes, and mental health rehospitalization rates correlate with COI, suggesting that neighborhood factors may influence outcome disparities for these conditions. Hospital outcomes may be affected by neighborhood opportunity, which has implications for benchmarking.
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- 2022
7. Feasibility of a Centralized, Pharmacy-Led Penicillin Allergy Delabeling Program
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James W. Antoon, Carlos G. Grijalva, Alison G. Grisso, Cosby A. Stone, Jakobi Johnson, Justine Stassun, Allison E. Norton, Sunil Kripalani, and Derek J. Williams
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Sexually Transmitted Diseases ,Infant ,Pilot Projects ,General Medicine ,Penicillins ,Pharmacy ,Pediatrics ,Article ,Anti-Bacterial Agents ,Drug Hypersensitivity ,Pediatrics, Perinatology and Child Health ,Feasibility Studies ,Humans ,Prospective Studies ,Child - Abstract
BACKGROUND Penicillin allergy labels are often inaccurate in children and removing unnecessary labels results in improved outcomes and lower health care costs. Although the hospital setting is a frequent point of contact for children, strategies to evaluate penicillin allergies in the hospital are lacking. METHODS We performed a prospective pilot study to determine the feasibility of a centralized, pharmacy-led approach to penicillin allergy evaluation. Children with a reported history of penicillin allergy admitted to our children’s hospital were risk-stratified and those stratified as low-risk underwent a single-dose oral challenge by a central pharmacist, regardless of the need for antibiotics. After the completion of each patient’s delabeling process, surveys were distributed to health care personnel involved in the patient’s care to collect perceptions on the acceptability, appropriateness, and feasibility of this intervention. Measures were scored by using a 5-point Likert scale. RESULTS Of the 23 patients who screened as low-risk, 20 underwent a penicillin allergy evaluation and an oral challenge. Of these, the penicillin allergy label was removed in 19 (95%) patients (Fig 1). The median age was 7 years (range 11 months–18 years). Participants rated the risk stratification and delabeling favorably overall, with high ratings on all 3 implementation measures: acceptability (mean 4.55, ± standard deviation [STD] 0.65), appropriateness (mean 4.58, STD ± 0.6), and feasibility (mean 4.51, STD ± 0.73). Measures of acceptability, appropriateness, and feasibility remained high when stratified by health care worker type and provider type. CONCLUSIONS Our findings provide support for systemic implementation of penicillin allergy delabeling strategies in hospitalized children.
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- 2023
8. Characteristics Associated With Serious Self-Harm Events in Children and Adolescents
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Mert Sekmen, Carlos G. Grijalva, Yuwei Zhu, Derek J. Williams, James A. Feinstein, Justine C. Stassun, Jakobi A. Johnson, Yasas C. Tanguturi, James C. Gay, and James W. Antoon
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Pediatrics, Perinatology and Child Health - Abstract
OBJECTIVES To identify patterns of psychiatric comorbidity among children and adolescents with a serious self-harm event. METHODS We studied children aged 5 to 18 years hospitalized with a neuropsychiatric event at 2 children’s hospitals from April 2016 to March 2020. We used Bayesian profile regression to identify distinct clinical profiles of risk for self-harm events from 32 covariates: age, sex, and 30 mental health diagnostic groups. Odds ratios (ORs) and 95% credible intervals (CIs) were calculated compared with a reference profile with the overall baseline risk of the cohort. RESULTS We included 1098 children hospitalized with a neuropsychiatric event (median age 14 years [interquartile range (IQR) 11–16]). Of these, 406 (37%) were diagnosed with a self-harm event. We identified 4 distinct profiles with varying risk for a self-harm diagnosis. The low-risk profile (median 0.035 [IQR 0.029–0.041]; OR 0.08, 95% CI 0.04–0.15) was composed primarily of children aged 5 to 9 years without a previous psychiatric diagnosis. The moderate-risk profile (median 0.30 [IQR 0.27–0.33]; reference profile) included psychiatric diagnoses without depressive disorders. Older female adolescents with a combination of anxiety, depression, substance, and trauma disorders characterized the high-risk profile (median 0.69 [IQR 0.67–0.70]; OR 5.09, 95% CI 3.11–8.38). Younger males with mood and developmental disorders represented the very high-risk profile (median 0.76 [IQR 0.73–0.79]; OR 7.21, 95% CI 3.69–15.20). CONCLUSIONS We describe 4 separate profiles of psychiatric comorbidity that can help identify children at elevated risk for a self-harm event and subsequent opportunities for intervention.
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- 2023
9. Trends in Pediatric Rhabdomyolysis and Associated Renal Failure: A 10-Year Population-Based Study
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Ladan, Agharokh, Isabella, Zaniletti, Andrew G, Yu, Benjamin C, Lee, Matt, Hall, Derek J, Williams, and Karen M, Wilson
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Hospitalization ,Male ,Adolescent ,Pediatrics, Perinatology and Child Health ,Humans ,Health Care Costs ,General Medicine ,Acute Kidney Injury ,Child ,Pediatrics ,Rhabdomyolysis ,Retrospective Studies - Abstract
OBJECTIVES Rhabdomyolysis in children is a highly variable condition with presentations ranging from myalgias to more severe complications like acute renal failure. We sought to explore demographics and incidence of pediatric rhabdomyolysis hospitalizations and rates of associated renal failure, as our current understanding is limited. METHODS This was a retrospective analysis using the Healthcare Cost and Utilization Project Kids’ Inpatient Database to identify children hospitalized with a primary diagnosis of rhabdomyolysis. Data were analyzed for demographic characteristics, as well as geographic and temporal trends. Multivariable logistic regression was used to identify characteristics associated with rhabdomyolysis-associated acute renal failure. RESULTS From 2006 to 2016, there were 8599 hospitalized children with a primary diagnosis of rhabdomyolysis. Overall, hospitalizations for pediatric rhabdomyolysis are increasing over time, with geographic peaks in the South and Northeast regions, and seasonal peaks in March and August. Though renal morbidity was diagnosed in 8.5% of children requiring hospitalization for rhabdomyolysis, very few of these patients required renal replacement therapy (0.41%), and death was rare (0.03%). Characteristics associated with renal failure included male sex, age greater than 15 years, and non-Hispanic Black race. CONCLUSIONS Though renal failure occurs at a significant rate in children hospitalized with rhabdomyolysis, severe complications, including death, are rare. The number of children hospitalized with rhabdomyolysis varies by geographic region and month of the year. Future studies are needed to explore etiologies of rhabdomyolysis and laboratory values that predict higher risk of morbidity and mortality in children with rhabdomyolysis.
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- 2022
10. Antibiotic clinical decision support for pneumonia in the ED: A randomized trial
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Derek J. Williams, Judith M. Martin, Hui Nian, Asli O. Weitkamp, Jason Slagle, Robert W. Turer, Srinivasan Suresh, Jakobi Johnson, Justine Stassun, Shari L. Just, Carrie Reale, Russ Beebe, Donald H. Arnold, James W. Antoon, Nancy S. Rixe, Laura F. Sartori, Robert E. Freundlich, Krow Ampofo, Andrew T. Pavia, Joshua C. Smith, Matthew B. Weinger, Yuwei Zhu, and Carlos G. Grijalva
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Leadership and Management ,Health Policy ,Fundamentals and skills ,General Medicine ,Assessment and Diagnosis ,Care Planning - Published
- 2023
11. Association of Radiology Findings with Etiology of Community Acquired Pneumonia Among Children from the Etiology of Pneumonia in the Community (EPIC) Study
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Sandra R. Arnold, Seema Jain, David Dansie, Herman Kan, Derek J. Williams, Krow Ampofo, Evan J. Anderson, Carlos G. Grijalva, Anna M. Bramley, Andrew T. Pavia, Kathryn M. Edwards, Vikki G. Nolan, Jonathan A. McCullers, and Robert A. Kaufman
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Pediatrics, Perinatology and Child Health - Published
- 2023
12. Identifying Acute Neuropsychiatric Events in Children and Adolescents
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James W. Antoon, James A. Feinstein, Carlos G. Grijalva, Yuwei Zhu, Emily Dickinson, Justine C. Stassun, Jakobi A. Johnson, Mert Sekmen, Yasas C. Tanguturi, James C. Gay, and Derek J. Williams
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Hospitalization ,Cross-Sectional Studies ,Adolescent ,Databases, Factual ,International Classification of Diseases ,Predictive Value of Tests ,Pediatrics, Perinatology and Child Health ,Humans ,Brief Reports ,General Medicine ,Child ,Pediatrics ,Algorithms - Abstract
OBJECTIVES The objective of this study was to develop and validate an approach to accurately identify incident pediatric neuropsychiatric events (NPEs) requiring hospitalization by using administrative data. METHODS We performed a cross-sectional, multicenter study of children 5 to 18 years of age hospitalized at two US children’s hospitals with an NPE. We developed and evaluated 3 NPE identification algorithms: (1) primary or secondary NPE International Classification of Diseases, 10th Revision diagnosis alone, (2) NPE diagnosis, the NPE was present on admission, and the primary diagnosis was not malignancy- or surgery-related, and (3) identical to algorithm 2 but without requiring the NPE be present on admission. The positive predictive value (PPV) of each algorithm was calculated overall and by diagnosis field (primary or secondary), clinical significance, and NPE subtype. RESULTS There were 1098 NPE hospitalizations included in the study. A total of 857 confirmed NPEs were identified for algorithm 1, yielding a PPV of 0.78 (95% confidence interval [CI] 0.76–0.80). Algorithm 2 (n = 846) had an overall PPV of 0.89 (95% CI 0.87–0.91). For algorithm 3 (n = 938), the overall PPV was 0.86 (95% CI 0.83–0.88). PPVs varied by diagnosis order, NPE clinical significance, and subtype. The PPV for critical clinical significance was 0.99 (0.97–0.99) for all 3 algorithms. CONCLUSIONS We identified a highly accurate method to identify neuropsychiatric adverse events in children and adolescents. The use of these approaches will improve the rigor of future studies of NPE, including the necessary evaluations of medication adverse events, infections, and chronic conditions.
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- 2022
13. Child Opportunity Index 2.0 and acute care utilization among children with medical complexity
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Cristin Q. Fritz, Matt Hall, Jessica L. Bettenhausen, Andrew F. Beck, Molly K. Krager, Katherine L. Freundlich, Dena Ibrahim, Joanna E. Thomson, James C. Gay, Alison R. Carroll, Maya Neeley, Patricia A. Frost, Alison C. Herndon, Allysa L. Kehring, and Derek J. Williams
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Leadership and Management ,Health Policy ,General Medicine ,Assessment and Diagnosis ,Article ,Hospitals ,Patient Discharge ,Hospitalization ,Intensive Care Units ,Cross-Sectional Studies ,Humans ,Fundamentals and skills ,Child ,Emergency Service, Hospital ,Care Planning ,Retrospective Studies - Abstract
BACKGROUND: Disproportionately high acute care utilization among children with medical complexity (CMC) is influenced by patient-level social complexity. OBJECTIVE: The objective of this study was to determine associations between ZIP code level opportunity and acute care utilization among CMC. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional, multicenter study used the Pediatric Health Information Systems database, identifying encounters between 2016–2019. CMC aged 28 days to
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- 2022
14. Gastrointestinal Microbiome Disruption and Antibiotic-Associated Diarrhea in Children Receiving Antibiotic Therapy for Community-Acquired Pneumonia
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Jiye Kwon, Yong Kong, Martina Wade, Derek J Williams, Clarence Buddy Creech, Scott Evans, Emmanuel B Walter, Judy M Martin, Jeffrey S Gerber, Jason G Newland, Meghan E Hofto, Mary Allen Staat, Henry F Chambers, Vance G Fowler, W Charles Huskins, and Melinda M Pettigrew
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Community-Acquired Infections ,Diarrhea ,Infectious Diseases ,Child, Preschool ,Major Article ,Humans ,Infant ,Immunology and Allergy ,Pneumonia ,beta-Lactams ,Anti-Bacterial Agents ,Gastrointestinal Microbiome - Abstract
Antibiotic-associated diarrhea (AAD) is a common side effect of antibiotics. We examined the gastrointestinal microbiota in children treated with β-lactams for community-acquired pneumonia. Data were from 66 children (n = 198 samples), aged 6–71 months, enrolled in the SCOUT-CAP trial (NCT02891915). AAD was defined as ≥1 day of diarrhea. Stool samples were collected on study days 1, 6–10, and 19–25. Samples were analyzed using 16S ribosomal RNA gene sequencing to identify associations between patient characteristics, microbiota characteristics, and AAD (yes/no). Nineteen (29%) children developed AAD. Microbiota compositional profiles differed between AAD groups (permutational multivariate analysis of variance, P < .03) and across visits (P < .001). Children with higher baseline relative abundances of 2 Bacteroides species were less likely to experience AAD. Higher baseline abundance of Lachnospiraceae and amino acid biosynthesis pathways were associated with AAD. Children in the AAD group experienced prolonged dysbiosis (P < .05). Specific gastrointestinal microbiota profiles are associated with AAD in children.
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- 2022
15. Variation in Dexamethasone Dosing and Use Outcomes for Inpatient Croup
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Mersine A. Bryan, Chuan Zhou, Karen M. Wilson, Rita Mangione-Smith, Irit R. Rasooly, David P. Johnson, Derek J. Williams, Amy Tyler, Hannah C. Neubauer, and Chén C. Kenyon
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Pediatrics ,medicine.medical_specialty ,Dexamethasone ,Article ,medicine ,Humans ,Prospective Studies ,Dosing ,Child ,Prospective cohort study ,Croup ,Inpatients ,business.industry ,Infant ,General Medicine ,Odds ratio ,Length of Stay ,medicine.disease ,Random effects model ,Confidence interval ,Relative risk ,Pediatrics, Perinatology and Child Health ,business ,medicine.drug - Abstract
OBJECTIVES Evaluate the association between dexamethasone dosing and outcomes for children hospitalized with croup. METHODS This study was nested within a multisite prospective cohort study of children aged 6 months to 6 years admitted to 1 of 5 US children’s hospitals between July 2014 and June /2016. Multivariable linear and logistic mixed-effects regression models were used to examine the association between the number of dexamethasone doses (1 vs >1) and outcomes (length of stay [LOS], cost, and 30-day same-cause reuse). All multivariable analyses included a site-specific random effect to account for clustering within hospital and were adjusted for age, sex, race and ethnicity, presenting severity, medical complexity, insurance, caregiver education, and hospital. In cost analyses, we controlled for LOS. RESULTS Among 234 children hospitalized with croup, patient characteristics did not differ by number of doses. The proportion receiving >1 dose varied by hospital (range 27.9%–57.1%). In adjusted analyses, >1 dose was not associated with same-cause reuse (odds ratio 0.87 [95% confidence interval (CI): 0.26 to 2.95]) but was associated with 45% longer LOS (relative risk = 1.45 [95% CI: 1.30 to 1.62]). When we controlled for LOS, >1 dose was not associated with differential cost ($−31.2 [95% CI $−424.4 to $362.0]). Eighty-two (35%) children received dexamethasone before presentation. CONCLUSIONS We found significant interhospital variation in dexamethasone dosing and LOS. When we controlled for severity on presentation, >1 dexamethasone dose was associated with longer LOS but not reuse. Although incomplete adjustment for severity is one possible explanation, some providers may routinely keep children hospitalized to administer multiple dexamethasone doses.
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- 2021
16. Obesity and Health-Related Quality of Life in Children Hospitalized for Acute Respiratory Illness
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Davene R. Wright, Rita Mangione-Smith, David P. Johnson, Elizabeth E. Halvorson, Talia A. Hitt, Joyee G. Vachani, Matthew Test, Derek J. Williams, Joel S. Tieder, and Chuan Zhou
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Pediatrics ,medicine.medical_specialty ,Population ,Overweight ,Body Mass Index ,Quality of life ,Surveys and Questionnaires ,Humans ,Medicine ,Obesity ,Prospective Studies ,Child ,education ,Prospective cohort study ,Research Articles ,Asthma ,education.field_of_study ,business.industry ,General Medicine ,medicine.disease ,Pneumonia ,Cross-Sectional Studies ,Pediatrics, Perinatology and Child Health ,Quality of Life ,medicine.symptom ,business ,Psychosocial - Abstract
OBJECTIVES Obesity has rapidly become a major problem for children that has adverse effects on respiratory health. We sought to assess the impact of obesity on health-related quality of life (HRQOL) and hospital outcomes for children hospitalized with asthma or pneumonia. METHODS In this multicenter prospective cohort study, we evaluated children (aged 2–16 years) hospitalized with an acute asthma exacerbation or pneumonia between July 1, 2014, and June 30, 2016. Subjects or their family completed surveys for child HRQOL (PedsQL Physical Functioning and Psychosocial Functioning Scales, with scores ranging from 0 to 100) on hospital presentation and 2–6 weeks after discharge. BMI categories were defined as normal weight, overweight, and obesity on the basis of BMI percentiles for age and sex per national guidelines. Multivariable regression models were used to examine associations between BMI category and HRQOL, length of stay, and 30-day reuse. RESULTS Among 716 children, 82 (11.4%) were classified as having overweight and 138 (19.3%) as having obesity. For children hospitalized with asthma or pneumonia, obesity was not associated with worse HRQOL at presentation or 2–6 weeks after discharge, hospital length of stay, or 30-day reuse. CONCLUSIONS Nearly 1 in 3 children seen in the hospital for an acute asthma exacerbation or pneumonia had overweight or obesity; however, among the population of children in our study, obesity alone does not appear to be associated with worse HRQOL or hospital outcomes.
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- 2021
17. COVID-19 and Acute Neurologic Complications in Children
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James W. Antoon, Matt Hall, Leigh M. Howard, Alison Herndon, Katherine L. Freundlich, Carlos G. Grijalva, and Derek J. Williams
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Hospitalization ,Brain Diseases ,Cross-Sectional Studies ,SARS-CoV-2 ,Chronic Disease ,Pediatrics, Perinatology and Child Health ,Humans ,COVID-19 ,Nervous System Diseases ,Child ,Retrospective Studies - Abstract
BACKGROUND Little is known about the epidemiology and outcomes of neurologic complications associated with coronavirus disease 2019 (COVID-19) in children. METHODS We performed a cross-sectional study of children 2 months to RESULTS Of 15 137 children hospitalized with COVID-19, 1060 (7.0%) had a concurrent diagnosis of a neurologic complication. The most frequent neurologic complications were febrile seizures (3.9%), nonfebrile seizures (2.3%), and encephalopathy (2.2%). Hospital LOS, ICU admission, ICU LOS, 30 day readmissions, deaths, and hospital costs were higher in children with neurologic complications compared with those without complications. Factors associated with lower odds of neurologic complications included: younger age (adjusted odds ratio [aOR]: 0.97; 95% confidence interval [CI]: 0.96–0.98), occurrence during delta variant predominant time period (aOR: 0.71; 95% CI: 0.57–0.87), presence of a nonneurologic complex chronic condition (aOR: 0.80; 95% CI: 0.69–0.94). The presence of a neurologic complex chronic condition was associated with higher odds of neurologic complication (aOR 4.14, 95% CI 3.48–4.92). CONCLUSIONS Neurologic complications are common in children hospitalized with COVID-19 and are associated with worse hospital outcomes. Our findings emphasize the importance of COVID-19 immunization in children, especially in high-risk populations, such as those with neurologic comorbidity.
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- 2022
18. Red Blood Cell Distribution Width and Pediatric Community-Acquired Pneumonia Disease Severity
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Jaclyn Lee, Yuwei Zhu, Derek J. Williams, Wesley H. Self, Sandra R. Arnold, Jonathan A. McCullers, Krow Ampofo, Andrew T. Pavia, Evan J. Anderson, Seema Jain, Kathryn M. Edwards, and Carlos G. Grijalva
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Community-Acquired Infections ,Erythrocyte Indices ,Erythrocytes ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Humans ,General Medicine ,Pneumonia ,Child ,Prognosis ,Pediatrics ,Severity of Illness Index ,Retrospective Studies - Abstract
BACKGROUND AND OBJECTIVES No standardized risk assessment tool exists for community-acquired pneumonia (CAP) in children. This study aims to investigate the association between red blood cell distribution width (RDW) and pediatric CAP. Methods Data prospectively collected by the Etiology of Pneumonia in the Community study (2010–2012) was used. Study population was pediatric patients admitted to tertiary care hospitals in Nashville and Memphis, Tennessee with clinically and radiographically confirmed CAP. The earliest measured RDW value on admission was used, in quintiles and also as a continuous variable. Outcomes analyzed were: severe CAP (requiring ICU, mechanical ventilation, vasopressor support, or death) or moderate CAP (hospital admission only). Analysis used multivariable logistic regression and restricted cubic splines modeling. RESULTS In 1459 eligible children, the median age was 29 months (interquartile range: 12–73), median RDW was 13.3% (interquartile range: 12.5–14.3), and 289 patients (19.8%) developed severe disease. In comparison with the lowest RDW quintile (Q1), the adjusted odds ratio (95% CI) for severe CAP in subsequent quintiles were, Q2: 1.20 (0.72–1.99); Q3: 1.28 (0.76–2.14); Q4: 1.69 (1.01–2.82); Q5: 1.25 (0.73–2.13). Consistently, RDW restricted cubic splines demonstrated an independent, nonlinear, positive association with CAP severity (P = .027), with rapid increases in the risk of severe CAP with RDW values up to 15%. CONCLUSIONS Higher presenting RDW was associated with an increased risk of severe CAP in hospitalized children. Widely available and inexpensive, RDW can serve as an objective data point to help with clinical assessments.
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- 2022
19. Mycoplasma Pneumoniae Testing and Treatment Among Children With Community-Acquired Pneumonia
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Thomas V. Brogan, Sanyukta Desai, Mark I. Neuman, Jeffrey S. Gerber, Lilliam Ambroggio, Derek J. Williams, Susan C. Lipsett, Matthew Hall, Anne J. Blaschke, Carlos G. Grijalva, Samir S. Shah, and Adam L. Hersh
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Mycoplasma pneumoniae ,medicine.medical_specialty ,medicine.drug_class ,medicine.disease_cause ,Pediatrics ,Macrolide Antibiotics ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Community-acquired pneumonia ,law ,030225 pediatrics ,Internal medicine ,Pneumonia, Mycoplasma ,Severity of illness ,medicine ,Humans ,030212 general & internal medicine ,Medical prescription ,Child ,Retrospective Studies ,business.industry ,Retrospective cohort study ,General Medicine ,medicine.disease ,Intensive care unit ,Anti-Bacterial Agents ,Community-Acquired Infections ,Pneumonia ,Pediatrics, Perinatology and Child Health ,Macrolides ,business - Abstract
OBJECTIVES To describe testing and treatment practices for Mycoplasma pneumoniae (Mp) among children hospitalized with community-acquired pneumonia (CAP). METHODS We conducted a retrospective cohort study using the Pediatric Health Information Systems database. We included children 3 months to 18 years old hospitalized with CAP between 2012 and 2018 and excluded children who were transferred from another hospital and those with complex chronic conditions. We examined the proportion of patients receiving Mp testing and macrolide therapy at the hospital level and trends in Mp testing and macrolide prescription over time. At the patient level, we examined differences in demographics, illness severity (eg, blood gas, chest tube placement), and outcomes (eg, ICU admission, length of stay, readmission) among patients with and without Mp testing. RESULTS Among 103 977 children hospitalized with CAP, 17.3% underwent Mp testing and 31.1% received macrolides. We found no correlation between Mp testing and macrolide treatment at the hospital level (R2 = 0.05; P = .11). Patients tested for Mp were more likely to have blood gas analysis (15.8% vs 12.8%; P < .1), chest tube placement (1.4% vs 0.8%; P < .1), and ICU admission (3.1% vs 1.4%; P < .1). Mp testing increased (from 15.8% to 18.6%; P < .001), and macrolide prescription decreased (from 40.9% to 20.6%; P < .001) between 2012 and 2018. CONCLUSIONS Nearly one-third of hospitalized children with CAP received macrolide antibiotics, although macrolide prescription decreased over time. Clinicians were more likely to perform Mp testing in children with severe illness, and Mp testing and macrolide treatment were not correlated at the hospital level.
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- 2021
20. Prevalence and Quantification of Secondhand Smoke Exposure Among Hospitalized Children <6 Years of Age
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Yuwei Zhu, Clark Stallings, Kathryn M. Edwards, Carlos G. Grijalva, Derek J. Williams, and Wesley H. Self
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Passive smoking ,Urinary system ,medicine.disease_cause ,complex mixtures ,Pediatrics ,Nicotine ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Interquartile range ,030225 pediatrics ,Environmental health ,Prevalence ,medicine ,Humans ,030212 general & internal medicine ,Child ,Cotinine ,Secondhand smoke ,business.industry ,Smoking ,Environmental Exposure ,General Medicine ,medicine.disease ,Pneumonia ,chemistry ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Hospital admission ,Tobacco Smoke Pollution ,Brief Reports ,business ,Child, Hospitalized ,medicine.drug - Abstract
OBJECTIVES: Using caregiver report and urinary cotinine measures, we defined the prevalence of secondhand smoke (SHS) exposure among young, hospitalized children and compared exposure among those hospitalized with pneumonia versus those with acute, nonrespiratory illnesses. METHODS: Children aged RESULTS: Overall, 36% of the 239 enrolled children had reported home SHS exposure, although 77% had detectable levels of urinary cotinine, including 59% with heavy exposure. The highest urinary cotinine level was among children exposed to indoor smoking (7.78 ng/mL, interquartile range 2.93–18.65; P < .001). Increased SHS exposure was associated with non-Hispanic ethnicity, lower household educational attainment, and public insurance. There were no differences in SHS exposure by diagnosis. CONCLUSIONS: Among hospitalized young children, reported home SHS exposure was common but substantially underestimated when compared with urinary cotinine levels. The highest urinary cotinine levels were among children exposed to indoor smoking. Future public health interventions, as well as more robust SHS exposure screenings on hospital admission, are needed to reduce the prevalence of SHS exposure among young children.
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- 2021
21. Guideline-Concordant Antiviral Treatment in Children at High Risk for Influenza Complications
- Author
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James W Antoon, Matt Hall, James A Feinstein, Kathryn E Kyler, Samir S Shah, Sonya Tang Girdwood, Jennifer L Goldman, Carlos G Grijalva, and Derek J Williams
- Subjects
Microbiology (medical) ,Infectious Diseases ,Major Article - Abstract
Background National guidelines recommend antiviral treatment for children with influenza at high risk for complications regardless of symptom duration. Little is known about concordance of clinical practice with this recommendation. Methods We performed a cross-sectional study of outpatient children (aged 1–18 years) at high risk for complications who were diagnosed with influenza during the 2016–2019 influenza seasons. High-risk status was determined using an existing definition that includes age, comorbidities, and residence in a long-term care facility. The primary outcome was influenza antiviral dispensing within 2 days of influenza diagnosis. We determined patient- and provider-level factors associated with guideline-concordant treatment using multivariable logistic regression. Results Of the 274 213 children with influenza at high risk for influenza complications, 159 350 (58.1%) received antiviral treatment. Antiviral treatment was associated with the presence of asthma (aOR, 1.13; 95% confidence interval [CI], 1.11–1.16), immunosuppression (aOR, 1.10; 95% CI, 1.05–1.16), complex chronic conditions (aOR, 1.04; 95% CI, 1.01–1.07), and index encounter in the urgent care setting (aOR, 1.3; 95% CI, 1.26–1.34). Factors associated with decreased odds of antiviral treatment include age 2–5 years compared with 6–17 years (aOR, 0.95; 95% CI, .93–.97), residing in a chronic care facility (aOR, .61; 95% CI, .46–.81), and index encounter in an emergency department (aOR, 0.66; 95% CI, .63–.71). Conclusions Among children with influenza at high risk for complications, 42% did not receive guideline-concordant antiviral treatment. Further study is needed to elucidate barriers to appropriate use of antivirals in this vulnerable population.
- Published
- 2022
22. Associations between comorbidity-related functional limitations and pneumonia outcomes
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Chastity Greene, Hui Nian, Yuwei Zhu, James W. Antoon, Katherine L. Freundlich, Krow Ampofo, Laura F. Sartori, Jakobi Johnson, Donald H. Arnold, Per Gesteland, Justine Stassun, Jeff Robison, Andrew T. Pavia, Carlos G. Grijalva, and Derek J. Williams
- Subjects
Leadership and Management ,Health Policy ,General Medicine ,Comorbidity ,Pneumonia ,Assessment and Diagnosis ,Length of Stay ,Respiration, Artificial ,Article ,Hospitalization ,Humans ,Fundamentals and skills ,Child ,Care Planning - Abstract
BACKGROUND: Underlying comorbidities are common in children with pneumonia. OBJECTIVE: To determine associations between comorbidity-related functional limitations and risk for severe pneumonia outcomes. DESIGN, SETTING, AND PARTICIPANTS: We prospectively enrolled children
- Published
- 2022
23. Associations Between Quality Measures and Outcomes for Children Hospitalized With Bronchiolitis
- Author
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Amy Tyler, Chuan Zhou, Tamara D. Simon, Mersine A. Bryan, Rita Mangione-Smith, David P. Johnson, Heather Haq, Chén C. Kenyon, and Derek J. Williams
- Subjects
Male ,medicine.medical_specialty ,Quality management ,Patient demographics ,media_common.quotation_subject ,MEDLINE ,Pediatrics ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,Blood culture ,Quality (business) ,030212 general & internal medicine ,Child ,Research Articles ,Quality Indicators, Health Care ,media_common ,medicine.diagnostic_test ,Public health insurance ,business.industry ,Infant ,General Medicine ,Length of Stay ,Hospitals, Pediatric ,medicine.disease ,Quality Improvement ,Bronchiolitis ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Mixed effects ,business - Abstract
OBJECTIVES: To use adherence to the Pediatric Respiratory Illness Measurement System (PRIMES) indicators to evaluate the strength of associations for individual indicators with length of stay (LOS) and cost for bronchiolitis. METHODS: We prospectively enrolled children with bronchiolitis at 5 children’s hospitals between July 1, 2014, and June 30, 2016. We examined associations between adherence to each individual PRIMES indicator for bronchiolitis and LOS and cost. Sixteen indicators were included, 9 “overuse” indicators for care that should not occur and 7 “underuse” indicators for care that should occur. We performed mixed effects linear regression to examine the association between adherence to each individual indicator and LOS (hours) and cost (dollars). All models controlled for patient demographics, patient complexity, and hospital. RESULTS: We enrolled 699 participants. The mean age was 8 months; 56% were male, 38% were white, and 63% had public insurance. Three indicators were significantly associated with shorter LOS and lower cost. All 3 indicators were overuse indicators and related to laboratory testing: no blood cultures (adjusted mean difference in LOS: −24.3 hours; adjusted mean cost difference: −$731, P < .001), no complete blood cell counts (LOS: −17.8 hours; cost: −$399, P < .05), and no respiratory syncytial virus testing (LOS: −16.6 hours; cost: −$272, P < .05). Two underuse indicators were associated with higher cost: documentation of oral intake at discharge ($671, P < .01) and documentation of hospital follow-up ($538, P < .05). CONCLUSIONS: A subset of PRIMES quality indicators for bronchiolitis are strongly associated with improved outcomes and can serve as important measures for future quality improvement efforts.
- Published
- 2020
24. Association Between Procalcitonin and Antibiotics in Children With Community-Acquired Pneumonia
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Mert Sekmen, Jakobi Johnson, Yuwei Zhu, Laura F. Sartori, Carlos G. Grijalva, Justine Stassun, Donald H. Arnold, Krow Ampofo, Jeff Robison, Per H. Gesteland, Andrew T. Pavia, and Derek J. Williams
- Subjects
Calcitonin ,Community-Acquired Infections ,Pediatrics, Perinatology and Child Health ,Humans ,General Medicine ,Pneumonia ,Child ,Pediatrics ,Procalcitonin ,Anti-Bacterial Agents - Abstract
OBJECTIVE To determine whether empirical antibiotic initiation and selection for children with pneumonia was associated with procalcitonin (PCT) levels when results were blinded to clinicians. METHODS We enrolled children RESULTS We enrolled 488 children (median PCT, 0.37 ng/mL; interquartile range [IQR], 0.11–2.38); 85 (17%) received no antibiotics (median PCT, 0.32; IQR, 0.09–1.33). Among the 403 children receiving antibiotics, 95 (24%) received narrow-spectrum therapy (median PCT, 0.24; IQR, 0.08–2.52) and 308 (76%) received broad-spectrum (median PCT, 0.46; IQR, 0.12–2.83). In adjusted analyses, PCT values were not associated with antibiotic initiation (odds ratio [OR], 1.02, 95% confidence interval [CI], 0.97%–1.06%) or empirical antibiotic selection (OR 1.07; 95% CI, 0.97%–1.17%). Of those with noncritical illness, 246 (69%) were identified as potential targets for antibiotic stewardship interventions. CONCLUSION Neither antibiotic initiation nor empirical antibiotic selection were associated with PCT values. Whereas other factors may inform antibiotic treatment decisions, the observed discordance between objective likelihood of bacterial etiology and antibiotic use suggests important opportunities for stewardship.
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- 2022
25. Development and Testing of an Emergency Department Quality Measure for Pediatric Suicidal Ideation and Self-Harm
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Layla Parast, Q Burkhart, Naomi S. Bardach, Robert Thombley, William T. Basco, Greg Barabell, Derek J. Williams, Ed Mitchel, Edison Machado, Priya Raghavan, Anagha Tolpadi, and Rita Mangione-Smith
- Subjects
Male ,Adolescent ,emergency department ,Emergency Care ,Pediatrics ,Article ,self-harm ,Suicidal Ideation ,follow-up care ,Paediatrics and Reproductive Medicine ,Hospital ,Clinical Research ,Behavioral and Social Science ,Humans ,Child ,Preschool ,Quality Indicators, Health Care ,Pediatric ,Emergency Service ,Prevention ,Reproducibility of Results ,quality measure ,Health Services ,Serious Mental Illness ,United States ,Brain Disorders ,Health Care ,Suicide ,Mental Health ,Good Health and Well Being ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Quality Indicators ,Emergency Service, Hospital ,Self-Injurious Behavior - Abstract
ObjectiveTo develop and test a new quality measure assessing timeliness of follow-up mental health care for youth presenting to the emergency department (ED) with suicidal ideation or self-harm.MethodsBased on a conceptual framework, evidence review, and a modified Delphi process, we developed a quality measure assessing whether youth 5 to 17 years old evaluated for suicidal ideation or self-harm in the ED and discharged to home had a follow-up mental health care visit within 7 days. The measure was tested in 4 geographically dispersed states (California, Pennsylvania, South Carolina, Tennessee) using Medicaid administrative data. We examined measure feasibility of implementation, variation, reliability, and validity. To test validity, adjusted regression models examined associations between quality measure scores and subsequent all-cause and same-cause hospital readmissions/ED return visits.ResultsOverall, there were 16,486 eligible ED visits between September 1, 2014 and July 31, 2016; 53.5% of eligible ED visits had an associated mental health care follow-up visit within 7 days. Measure scores varied by state, ranging from 26.3% to 66.5%, and by youth characteristics: visits by youth who were non-White, male, and living in an urban area were significantly less likely to be associated with a follow-up visit within 7 days. Better quality measure performance was not associated with decreased reutilization.ConclusionsThis new ED quality measure may be useful for monitoring and improving the quality of care for this vulnerable population; however, future work is needed to establish the measure's predictive validity using more prevalent outcomes such as recurrence of suicidal ideation or deliberate self-harm.
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- 2022
26. Costs and Reimbursements for Mental Health Hospitalizations at Children’s Hospitals
- Author
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Whitney L. Browning, Stephanie K. Doupnik, Lisa Clewner-Newman, Heather Kreth, Evan Dalton, Maya Neeley, Derek J. Williams, Kate Morgan, Matthew Hall, Alison Herndon, Hannah Griffith, My-Linh Ngo, Travis W. Crook, and Greg Plemmons
- Subjects
medicine.medical_specialty ,Leadership and Management ,Poison control ,Assessment and Diagnosis ,Suicide prevention ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Injury prevention ,Humans ,Medicine ,030212 general & internal medicine ,Hospital Costs ,Child ,Care Planning ,Reimbursement ,Inpatients ,Suicide attempt ,business.industry ,Brief Report ,Health Policy ,Human factors and ergonomics ,General Medicine ,Hospitals, Pediatric ,Mental health ,Hospitalization ,Mental Health ,Emergency medicine ,Fundamentals and skills ,business - Abstract
The financial impact of the rising number of pediatric mental health hospitalizations is unknown. Therefore, this study assessed costs, reimbursements, and net profits or losses for 111,705 mental health and non–mental health medical hospitalizations in children’s hospitals with use of the Pediatric Health Information System and Revenue Management Program. Average financial margins were calculated as (reimbursement per day) – (cost per day), and they were lowest for mental health hospitalizations ($136/day), next lowest for suicide attempt ($518/day), and highest for other medical hospitalizations ($611/day). For 10 of 17 hospitals, margin per day for mental health hospitalizations was lower than margin per day for other medical hospitalizations. For these 10 hospitals, the total net loss for inpatient and observation status mental health hospitalizations, compared with other medical hospitalizations, was $27 million (median, $2.2 million per hospital). Financial margins were usually lower for mental health vs non–mental health medical hospitalizations. Journal of Hospital Medicine 2020;15:727- 730. © 2020 Society of Hospital Medicine
- Published
- 2020
27. Vaccination Status and Adherence to Quality Measures for Acute Respiratory Tract Illnesses
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Chén C. Kenyon, Amy Tyler, Chuan Zhou, Mersine A. Bryan, Tamara D. Simon, Annika M. Hofstetter, Douglas J. Opel, Joyee G. Vachani, Derek J. Williams, and Rita Mangione-Smith
- Subjects
Male ,medicine.medical_specialty ,Vaccination Coverage ,Adolescent ,Quality Assurance, Health Care ,Respiratory Tract Diseases ,Health Services Misuse ,Logistic regression ,Pediatrics ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Internal medicine ,Health care ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Healthcare Disparities ,Hospital Costs ,Practice Patterns, Physicians' ,Child ,Prospective cohort study ,Immunization Schedule ,Research Articles ,Quality Indicators, Health Care ,Asthma ,business.industry ,Infant, Newborn ,Infant ,General Medicine ,Length of Stay ,Hospitals, Pediatric ,medicine.disease ,United States ,Confidence interval ,Pneumonia ,Logistic Models ,Bronchiolitis ,Child, Preschool ,Croup ,Acute Disease ,Practice Guidelines as Topic ,Pediatrics, Perinatology and Child Health ,Linear Models ,Female ,Guideline Adherence ,business - Abstract
OBJECTIVES: To assess the relationship between vaccination status and clinician adherence to quality measures for children with acute respiratory tract illnesses. METHODS: We conducted a multicenter prospective cohort study of children aged 0 to 16 years who presented with 1 of 4 acute respiratory tract illness diagnoses (community-acquired pneumonia, croup, asthma, and bronchiolitis) between July 2014 and June 2016. The predictor variable was provider-documented up-to-date (UTD) vaccination status. Our primary outcome was clinician adherence to quality measures by using the validated Pediatric Respiratory Illness Measurement System (PRIMES). Across all conditions, we examined overall PRIMES composite scores and overuse (including indicators for care that should not be provided, eg, C-reactive protein testing in community-acquired pneumonia) and underuse (including indicators for care that should be provided, eg, dexamethasone in croup) composite subscores. We examined differences in length of stay, costs, and readmissions by vaccination status using adjusted linear and logistic regression models. RESULTS: Of the 2302 participants included in the analysis, 92% were documented as UTD. The adjusted mean difference in overall PRIMES scores by UTD status was not significant (adjusted mean difference −0.3; 95% confidence interval: −1.9 to 1.3), whereas the adjusted mean difference was significant for both overuse (−4.6; 95% confidence interval: −7.5 to −1.6) and underuse (2.8; 95% confidence interval: 0.9 to 4.8) composite subscores. There were no significant adjusted differences in mean length of stay, cost, and readmissions by vaccination status. CONCLUSIONS: We identified lower adherence to overuse quality indicators and higher adherence to underuse quality indicators for children not UTD, which suggests that clinicians “do more” for hospitalized children who are not UTD.
- Published
- 2020
28. Social Disadvantage, Access to Care, and Disparities in Physical Functioning Among Children Hospitalized with Respiratory Illness
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Arti D. Desai, Rita Mangione-Smith, David P. Johnson, Derek J. Williams, Jakobi Johnson, Wren Haaland, K. Casey Lion, Chuan Zhou, Chén C. Kenyon, and Michelle A. Lopez
- Subjects
Male ,Gerontology ,Adolescent ,Leadership and Management ,Ethnic group ,MEDLINE ,Assessment and Diagnosis ,Tertiary care ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Physical functioning ,Surveys and Questionnaires ,030225 pediatrics ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Healthcare Disparities ,Child ,Poverty ,Respiratory Tract Infections ,Care Planning ,Minority Groups ,Original Research ,Respiratory illness ,business.industry ,Health Policy ,General Medicine ,Physical Functional Performance ,Hospitals, Pediatric ,Hospitalization ,Caregivers ,Limited English proficiency ,Quality of Life ,Female ,Fundamentals and skills ,Social disadvantage ,business - Abstract
Background and objectives Understanding disparities in child health-related quality of life (HRQoL) may reveal opportunities for targeted improvement. This study examined associations between social disadvantage, access to care, and child physical functioning before and after hospitalization for acute respiratory illness. Methods From July 1, 2014, to June 30, 2016, children ages 8-16 years and/or caregivers of children 2 weeks to 16 years admitted to five tertiary care children's hospitals for three common respiratory illnesses completed a survey on admission and within 2 to 8 weeks after discharge. Survey items assessed social disadvantage (minority race/ ethnicity, limited English proficiency, low education, and low income), difficulty/delays accessing care, and baseline and follow-up HRQoL physical functioning using the Pediatric Quality of Life Inventory (PedsQL, range 0-100). We examined associations between these three variables at baseline and follow-up using multivariable, mixed-effects linear regression models with multiple imputation sensitivity analyses for missing data. Results A total of 1,325 patients and/or their caregivers completed both PedsQL assessments. Adjusted mean baseline PedsQL scores were significantly lower for patients with social disadvantage markers, compared with those of patients with none (78.7 for >3 markers versus 85.5 for no markers, difference -6.1 points (95% CI: -8.7, -3.5). The number of social disadvantage markers was not associated with mean follow-up PedsQL scores. Difficulty/delays accessing care were associated with lower PedsQL scores at both time points, but it was not a significant effect modifier between social disadvantage and PedsQL scores. Conclusions Having social disadvantage markers or difficulty/delays accessing care was associated with lower baseline physical functioning; however, differences were reduced after hospital discharge.
- Published
- 2020
29. PRO: Procalcitonin has clinical utility in children with community-acquired pneumonia
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Todd A Florin and Derek J. Williams
- Subjects
medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,For Debate ,Respiratory tract infections ,medicine.drug_class ,business.industry ,Antibiotics ,Patient subgroups ,Diagnostic accuracy ,medicine.disease ,bacterial infections and mycoses ,Procalcitonin ,Pneumonia ,Viewpoint ,AcademicSubjects/MED00290 ,Community-acquired pneumonia ,Childhood pneumonia ,parasitic diseases ,medicine ,AcademicSubjects/MED00740 ,Intensive care medicine ,business ,AcademicSubjects/MED00230 ,hormones, hormone substitutes, and hormone antagonists - Abstract
Procalcitonin (PCT) is a useful, albeit imperfect, diagnostic aid that can help clinicians make more informed decisions around antibiotic use in children with lower respiratory tract infections (LRTI), including community-acquired pneumonia (CAP). Recent data suggest that a very low PCT concentration has a high negative predictive value to identify a population of children at low risk of typical bacterial infections. Although the preponderance of data on the clinical utility of PCT in LRTI come from adult studies, the potential for benefit is likely greatest in paediatric CAP and other LRTIs where viral aetiologies predominate, yet antibiotics are frequently prescribed.
- Published
- 2021
30. Factors Associated With COVID-19 Disease Severity in US Children and Adolescents
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Cary Thurm, Carlos G. Grijalva, Chén C. Kenyon, James W. Antoon, Julianne E. Burns, Troy Richardson, Derek J. Williams, Alicen B Spaulding, Mario A Reyes, Samir S. Shah, Adam L. Hersh, and Ronald J. Teufel
- Subjects
Pediatrics ,medicine.medical_specialty ,Adolescent ,Leadership and Management ,Disease ,Assessment and Diagnosis ,Lower risk ,Severity of Illness Index ,law.invention ,law ,Severity of illness ,medicine ,Humans ,Child ,Care Planning ,Asthma ,Original Research ,Retrospective Studies ,business.industry ,SARS-CoV-2 ,Health Policy ,COVID-19 ,Retrospective cohort study ,General Medicine ,Odds ratio ,Emergency department ,medicine.disease ,Intensive care unit ,Diabetes Mellitus, Type 2 ,Child, Preschool ,Fundamentals and skills ,business - Abstract
Background Little is known about the clinical factors associated with COVID-19 disease severity in children and adolescents. Methods We conducted a retrospective cohort study across 45 US children's hospitals between April 2020 to September 2020 of pediatric patients discharged with a primary diagnosis of COVID-19. We assessed factors associated with hospitalization and factors associated with clinical severity (eg, admission to inpatient floor, admission to intensive care unit [ICU], admission to ICU with mechanical ventilation, shock, death) among those hospitalized. Results Among 19,976 COVID-19 encounters, 15,913 (79.7%) patients were discharged from the emergency department (ED) and 4063 (20.3%) were hospitalized. The clinical severity distribution among those hospitalized was moderate (3222, 79.3%), severe (431, 11.3%), and very severe (380, 9.4%). Factors associated with hospitalization vs discharge from the ED included private payor insurance (adjusted odds ratio [aOR],1.16; 95% CI, 1.1-1.3), obesity/type 2 diabetes mellitus (type 2 DM) (aOR, 10.4; 95% CI, 8.9-13.3), asthma (aOR, 1.4; 95% CI, 1.3-1.6), cardiovascular disease, (aOR, 5.0; 95% CI, 4.3- 5.8), immunocompromised condition (aOR, 5.9; 95% CI, 5.0-6.7), pulmonary disease (aOR, 5.3; 95% CI, 3.4-8.2), and neurologic disease (aOR, 3.2; 95% CI, 2.7-5.8). Among children and adolescents hospitalized with COVID-19, greater disease severity was associated with Black or other non-White race; age greater than 4 years; and obesity/type 2 DM, cardiovascular, neuromuscular, and pulmonary conditions. Conclusions Among children and adolescents presenting to US children's hospital EDs with COVID-19, 20% were hospitalized; of these, 21% received care in the ICU. Older children and adolescents had a lower risk for hospitalization but more severe illness when hospitalized. There were differences in disease severity by race and ethnicity and the presence of selected comorbidities. These factors should be taken into consideration when prioritizing mitigation and vaccination strategies.
- Published
- 2021
31. Pediatric Firearm-Related Hospital Encounters During the SARS-CoV-2 Pandemic
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Patricia A. Frost, Whitney L. Browning, Derek J. Williams, Shari Barkin, Cristin Q. Fritz, Alison R. Carroll, Jordee Wells, Carlos A. Plancarte, Matthew Hall, Kathleen Doherty, Monika K. Goyal, Kelsey A.B. Gastineau, Katherine L. Freundlich, and Heather Kreth
- Subjects
medicine.medical_specialty ,business.industry ,Pediatric health ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Emergency department ,Article ,Primary outcome ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Pandemic ,Medicine ,business ,Psychosocial ,Cause of death - Abstract
* Abbreviations: ED — : emergency department ICD-10 — : International Classification of Diseases, 10th Revision PHIS — : Pediatric Health Information System SARS-CoV-2 — : severe acute respiratory syndrome coronavirus 2 In the United States, 4.6 million children live in a home with an unsecured firearm, increasing their risk for firearm-related injuries, which are the second leading cause of death in US children.1,2 In 2020, the United States witnessed an unprecedented rise in firearm sales as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic strained communities with additional psychosocial and economic stressors.3 Current literature evaluating firearm injuries and the SARS-CoV-2 pandemic includes only single-center data, adult populations, or young children, excluding pediatric suicide.4,5 We aimed to quantify pediatric firearm-related and total encounters during the initial 2020 SARS-CoV-2 pandemic period, as compared to these periods in the previous 3 years. We used International Classification of Diseases, 10th Revision (ICD-10) discharge diagnosis codes to conduct a cross-sectional comparison of pediatric (age 0–18 years) firearm-related and total emergency department (ED) and hospital encounters between calendar weeks 9 and 36 (corresponding to approximately March to August) 2020 and 2017–2019 at 44 US children’s hospitals participating in the Pediatric Health Information System (PHIS) database. The primary outcome was firearm-related encounters, defined as an initial encounter for a penetrating injury from a powder-charged weapon identified by … Address correspondence to Kelsey A.B. Gastineau, MD, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, 2200 Children’s Way, Nashville, TN 37232-9452. E-mail: kelsey.gastineau{at}vumc.org
- Published
- 2021
32. Decreasing the Use of Restraints on Children Admitted for Behavioral Health Conditions
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Sarah Hart, Allyson Witters Cundiff, D. Catherine Fuchs, Derek J. Williams, Ashley Ried, Alison C. Herndon, Evan M. Dalton, Heather L. Kreth, Kate Morgan, David P. Johnson, and Andrea Hughie
- Subjects
Restraint, Physical ,medicine.medical_specialty ,Quality management ,Psychological intervention ,MEDLINE ,Child Behavior Disorders ,Hospitals, University ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Clinical Protocols ,030225 pediatrics ,Outcome Assessment, Health Care ,medicine ,Humans ,Child ,Patient Care Team ,business.industry ,Physical restraints ,Hospitals, Pediatric ,Quality Improvement ,Tennessee ,Hospital medicine ,Hospitalization ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Behavioral medicine ,Cohort ,Health diagnosis ,business ,Child, Hospitalized ,Procedures and Techniques Utilization - Abstract
OBJECTIVES Pediatric behavioral health admissions to children’s hospitals for disposition planning are steadily increasing. These children may exhibit violent behaviors, which can escalate to application of physical limb restraints for safety. Using quality improvement methodology, we sought to decrease physical restraint use on children admitted to our children’s hospital for behavioral health conditions from a baseline mean of 2.6% of behavioral health patient days to METHODS We included all children ≥3 years of age admitted to our hospital medicine service with a primary behavioral health diagnosis from July 1, 2016, to February 1, 2020. A multidisciplinary team, formed in July 2018, tested interventions based on key drivers targeted toward our aim. The primary outcome measure was the percent of behavioral health patient days on which physical restraints were ordered. The balancing measure was the percent of patient days with a staff injury event. Statistical process control charts were used to view and analyze data. RESULTS Our cohort included 3962 consecutive behavioral health patient encounters, encompassing a total of 9758 patient days. A 2-year baseline revealed physical restraint orders placed on 2.6% of behavioral health patient days, which was decreased to 0.9% after interventions and has been sustained over 19 months without any change in staff injuries. CONCLUSIONS Team-based quality improvement methodology was associated with a sustained reduction in physical restraint use on children admitted for behavioral health conditions to our children’s hospital. These results indicate that physical restraint use can be safely reduced in children’s hospitals.
- Published
- 2021
33. Trends in Length of Stay and Readmissions in Children's Hospitals
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Charlotte M. Brown, Derek J. Williams, Matt Hall, Katherine L. Freundlich, David P. Johnson, Carrie Lind, Kris Rehm, Patricia A. Frost, Stephanie K. Doupnik, Dena Ibrahim, Stephen Patrick, Leigh M. Howard, and James C. Gay
- Subjects
medicine.medical_specialty ,Pediatric health ,MEDLINE ,Pediatrics ,Patient Readmission ,Obstetric care ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Intensive care ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Child ,Diagnosis-Related Groups ,Retrospective Studies ,business.industry ,Infant, Newborn ,Retrospective cohort study ,General Medicine ,Length of Stay ,Hospitals, Pediatric ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Mixed effects ,Resource use ,business - Abstract
BACKGROUND AND OBJECTIVES:Patient complexity at US children’s hospitals is increasing. Hospitals experience concurrent pressure to reduce length of stay (LOS) and readmissions, yet little is known about how these common measures of resource use and quality have changed over time. Our aim was to examine temporal trends in medical complexity, hospital LOS, and readmissions across a sample of US children’s hospitals.METHODS:Retrospective cohort study of hospitalized patients from 42 children’s hospitals in the Pediatric Health Information System from 2013 to 2017. After excluding deaths, healthy newborns, obstetric care, and low volume service lines, we analyzed trends in medical complexity, LOS, and 14-day all-cause readmissions using generalized linear mixed effects models, adjusting for changes in patient factors and case-mix.RESULTS:Between 2013 and 2017, a total of 3 355 815 discharges were included. Over time, the mean case-mix index and the proportion of hospitalized patients with complex chronic conditions or receiving intensive care increased (P < .001 for all). In adjusted analyses, mean LOS declined 3% (61.1 hours versus 59.3 hours from 2013 to 2017, P < .001), whereas 14-day readmissions were unchanged (7.0% vs 6.9%; P = .03). Reductions in adjusted LOS were noted in both medical and surgical service lines (3.6% and 2.0% decline, respectively; P < .001).CONCLUSIONS:Across US children’s hospitals, adjusted LOS declined whereas readmissions remained stable, suggesting that children’s hospitals are providing more efficient care for an increasingly complex patient population.
- Published
- 2021
34. Predictors of Bacteremia in Children Hospitalized With Community-Acquired Pneumonia
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Samir S. Shah, Adam L. Hersh, Mark I. Neuman, Carlos G. Grijalva, Sanyukta Desai, Jeffrey S. Gerber, Lilliam Ambroggio, Anne J. Blaschke, Derek J. Williams, Matthew Hall, Susan C. Lipsett, and Thomas V. Brogan
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Bacteremia ,Intensive Care Units, Pediatric ,Pediatrics ,Leukocyte Count ,03 medical and health sciences ,0302 clinical medicine ,Community-acquired pneumonia ,Risk Factors ,030225 pediatrics ,White blood cell ,Internal medicine ,Pneumonia, Bacterial ,medicine ,Humans ,Blood culture ,030212 general & internal medicine ,Leukocytosis ,Child ,medicine.diagnostic_test ,business.industry ,Infant ,Retrospective cohort study ,General Medicine ,medicine.disease ,Confidence interval ,Community-Acquired Infections ,Hospitalization ,Pneumonia ,medicine.anatomical_structure ,Blood Culture ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,Radiography, Thoracic ,medicine.symptom ,business - Abstract
BACKGROUND AND OBJECTIVES: The yield of blood cultures in children hospitalized with community-acquired pneumonia (CAP) is low. Characteristics of children at increased risk of bacteremia remain largely unknown. METHODS: We conducted a secondary analysis of a retrospective cohort study of children aged 3 months to 18 years hospitalized with CAP in 6 children’s hospitals from 2007 to 2011. We excluded children with complex chronic conditions and children without blood cultures performed at admission. Clinical, laboratory, microbiologic, and radiologic data were assessed to identify predictors of bacteremia. RESULTS: Among 7509 children hospitalized with CAP, 2568 (34.2%) had blood cultures performed on the first day of hospitalization. The median age was 3 years. Sixty-five children with blood cultures performed had bacteremia (2.5%), and 11 children (0.4%) had bacteremia with a penicillin-nonsusceptible pathogen. The prevalence of bacteremia was increased in children with a white blood cell count >20 × 103 cells per µL (5.4%; 95% confidence interval 3.5%–8.1%) and in children with definite radiographic pneumonia (3.3%; 95% confidence interval 2.4%–4.4%); however, the prevalence of penicillin-nonsusceptible bacteremia was below 1% even in the presence of individual predictors. Among children hospitalized outside of the ICU, the prevalence of contaminated blood cultures exceeded the prevalence of penicillin-nonsusceptible bacteremia. CONCLUSIONS: Although the prevalence of bacteremia is marginally higher among children with leukocytosis or radiographic pneumonia, the rates remain low, and penicillin-nonsusceptible bacteremia is rare even in the presence of these predictors. Blood cultures should not be obtained in children hospitalized with CAP in a non-ICU setting.
- Published
- 2019
35. Agreement Between Two Procalcitonin Assays in Hospitalized Children
- Author
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Rendie McHenry, J. Eric Stanford, Ritu Banerjee, Sophie E Katz, Derek J. Williams, Meng Xu, Natasha B. Halasa, Laura F. Sartori, Jennifer M. Colby, and Andras Szeles
- Subjects
0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Concordance ,030106 microbiology ,Pediatrics ,Procalcitonin ,lcsh:Infectious and parasitic diseases ,Method comparison ,03 medical and health sciences ,fluids and secretions ,0302 clinical medicine ,Internal medicine ,parasitic diseases ,medicine ,lcsh:RC109-216 ,030212 general & internal medicine ,Plasma samples ,business.industry ,Brief Report ,Negative bias ,bacterial infections and mycoses ,3. Good health ,Infectious Diseases ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
Introduction Agreement between available procalcitonin (PCT) assays is unclear. We sought to compare concordance between Roche and bioMérieux PCT assays using pediatric samples. Methods We evaluated 213 plasma samples from 208 children. We tested each sample on both the Roche and bioMérieux PCT platforms. Results At ranges
- Published
- 2019
36. Association of Weekend Admission and Weekend Discharge with Length of Stay and 30-Day Readmission in Children’s Hospitals
- Author
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Jessica L, Markham, Troy, Richardson, Matthew, Hall, Christopher P, Bonafide, Derek J, Williams, Katherine A, Auger, Karen M, Wilson, Samir S, Shah, and Susan C, Walley
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Weekend effect ,Leadership and Management ,Pediatric health ,education ,Patient characteristics ,Assessment and Diagnosis ,Patient Readmission ,03 medical and health sciences ,Patient Admission ,0302 clinical medicine ,Interquartile range ,030225 pediatrics ,medicine ,Humans ,030212 general & internal medicine ,Child ,Care Planning ,Retrospective Studies ,business.industry ,Health Policy ,Infant, Newborn ,Infant ,General Medicine ,Length of Stay ,Hospitals, Pediatric ,Readmission rate ,Patient Discharge ,Hospitalization ,Cross-Sectional Studies ,Child, Preschool ,Emergency medicine ,Female ,Fundamentals and skills ,business ,human activities ,Readmission risk - Abstract
BACKGROUND Worse outcomes among adults presenting for/receiving care on weekends (ie, "the weekend effect") have been observed for many diseases. However, little is known about the overall impact of the weekend effect in hospitalized children. OBJECTIVE o determine the association between weekend admission and length of stay (LOS) and between weekend discharge and 30-day all-cause readmission. METHODS We conducted a retrospective, cross-sectional study of children hospitalized between October 1, 2014 and September 30, 2015 using the Pediatric Health Information System. Birth hospitalizations and planned procedures were excluded. We used generalized linear mixed modeling to assess the independent association between weekend admission and LOS and weekend discharge and readmission risk. RESULTS Among 390,745 hospitalizations across 43 hospitals, the median LOS was 41 hours (interquartile range [IQR] 24-71) and the 30-day readmission rate was 8.2% (IQR 7.2-9.4). We observed no association between weekend admission and LOS (adjusted LOS [95% CI: weekend 63.70 [61.01-66.52] hours vs weekday 63.40 [60.73-66.19] hours, P = .112). Weekend discharge was associated with slightly increased odds of readmission compared with weekday discharge (adjusted probability of readmission [95% CI]: weekend 0.13 [0.12-0.13] versus weekday 0.11 [0.11-0.12], P < .001) but was variable among individual hospitals. Patient characteristics (ie, number of chronic conditions) were more strongly associated with LOS and readmission risk than weekend admission or discharge. CONCLUSIONS Patient-level factors (ie, clinical and demographic characteristics) are more indicative of longer LOS and readmission risk than weekend admissions or discharges. The overall impact of the weekend effect across children's hospitals was minimal.
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- 2019
37. Serological response to influenza vaccination among adults hospitalized with community-acquired pneumonia
- Author
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Anna M. Bramley, D. Mark Courtney, Caroline Quinn Pratt, Wesley H. Self, Carlos G. Grijalva, Grant W. Waterer, Lynn Finelli, Stacie Jefferson, Yuwei Zhu, Kathryn M. Edwards, Evan J. Anderson, Derek J. Williams, Min Z. Levine, Seema Jain, and Richard G. Wunderink
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Hemagglutination ,Epidemiology ,030312 virology ,Antibodies, Viral ,medicine.disease_cause ,Serology ,03 medical and health sciences ,Influenza A Virus, H1N1 Subtype ,Short Article ,Community-acquired pneumonia ,Influenza, Human ,Influenza A virus ,Humans ,Medicine ,Prospective Studies ,Seroconversion ,Aged ,Chicago ,0303 health sciences ,business.industry ,Influenza A Virus, H3N2 Subtype ,Vaccination ,Public Health, Environmental and Occupational Health ,Antibody titer ,virus diseases ,Pneumonia ,Hemagglutination Inhibition Tests ,Middle Aged ,medicine.disease ,Tennessee ,Virology ,Community-Acquired Infections ,Hospitalization ,Infectious Diseases ,Influenza Vaccines ,RNA, Viral ,Female ,business - Abstract
Ninety‐five adults enrolled in the Etiology of Pneumonia in the Community study with negative admission influenza polymerase chain reaction (PCR) tests received influenza vaccination during hospitalization. Acute and convalescent influenza serology was performed. After vaccination, seropositive (≥1:40) hemagglutination antibody titers (HAI) were achieved in 55% to influenza A(H1N1)pdm09, 58% to influenza A(H3N2), 77% to influenza B (Victoria), and 74% to influenza B (Yamagata) viruses. Sixty‐six (69%) patients seroconverted (≥4‐fold HAI rise) to ≥1 strain. Failure to seroconvert was associated with diabetes, bacterial detection, baseline seropositive titers for influenza B (Yamagata), and influenza vaccination in the previous season.
- Published
- 2018
38. Low Admission Plasma Gelsolin Concentrations Identify Community-acquired Pneumonia Patients at High Risk for Severe Outcomes
- Author
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Thomas P. Stossel, Seema Jain, Evan J. Anderson, Susan L Levinson, Anna M. Bramley, Richard G. Wunderink, Mark J. DiNubile, Carlos G. Grijalva, Wesley H. Self, Derek J. Williams, and Kathryn M. Edwards
- Subjects
Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,030106 microbiology ,Population ,law.invention ,Young Adult ,03 medical and health sciences ,Patient Admission ,0302 clinical medicine ,Community-acquired pneumonia ,Interquartile range ,law ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Respiratory system ,education ,Articles and Commentaries ,Gelsolin ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Drug Resistance, Microbial ,Pneumonia ,Middle Aged ,Prognosis ,medicine.disease ,Intensive care unit ,Community-Acquired Infections ,Patient Outcome Assessment ,Infectious Diseases ,Quartile ,Female ,business ,Biomarkers - Abstract
BackgroundPlasma gelsolin (pGSN) is an abundant circulating protein that neutralizes actin exposed by damaged cells, modulates inflammatory responses, and enhances alveolar macrophage antimicrobial activity. We investigated whether adults with low pGSN at hospital admission for community-acquired pneumonia (CAP) were at high risk for severe outcomes.MethodsAdmission pGSN concentrations in 455 adults hospitalized with CAP were measured using enzyme-linked immunosorbent assay. Patients were grouped into the following 4 hierarchical, mutually exclusive categories based on maximum clinical severity experienced during their hospitalization: general floor care without intensive care unit (ICU) admission, invasive respiratory or vasopressor support (IRVS), or death; ICU care without IRVS or death; IRVS without death; or death. Admission pGSN concentrations were compared across these discrete outcome categories. Additionally, outcomes among patients in the lowest quartile of pGSN concentration were compared to those in the upper 3 quartiles.ResultsOverall, median (interquartile range) pGSN concentration was 38.1 (32.1, 45.7) μg/mL. Patients with more severe outcomes had lower pGSN concentrations (P = .0001); median values were 40.3 μg/mL for floor patients, 36.7 μg/mL for ICU patients, 36.5 μg/mL for patients receiving IRVS, and 25.7 μg/mL for patients who died. Compared to patients with higher pGSN concentrations, patients in the lowest quartile (pGSN ≤ 32.1 μg/mL) more often required IRVS (21.2% vs 11.7%, P = .0114) and died (8.8% vs 0.9%, P < .0001).ConclusionsAmong adults hospitalized with CAP, lower pGSN concentrations were associated with more severe clinical outcomes. Future studies are planned to investigate possible therapeutic benefits of recombinant human pGSN in this population.
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- 2018
39. Healthcare Encounter and Financial Impact of COVID-19 on Children’s Hospitals
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Jay G. Berry, Derek J. Williams, Matthew Hall, Samir S. Shah, Katherine A. Auger, Jessica L. Bettenhausen, Rustin B. Morse, David C Synhorst, and Cary Thurm
- Subjects
Coronavirus disease 2019 (COVID-19) ,Leadership and Management ,Assessment and Diagnosis ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Pandemic ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Child ,Care Planning ,Personal protective equipment ,Retrospective Studies ,Inpatients ,Financial impact ,business.industry ,SARS-CoV-2 ,Health Policy ,Brief Report ,COVID-19 ,Retrospective cohort study ,Health Care Costs ,General Medicine ,Emergency department ,medicine.disease ,Hospitals, Pediatric ,Editorial ,Fundamentals and skills ,Viral spread ,Medical emergency ,Emergency Service, Hospital ,business ,Delivery of Health Care - Abstract
Children’s hospitals responded to COVID-19 by limiting nonurgent healthcare encounters, conserving personal protective equipment, and restructuring care processes to mitigate viral spread. We assessed year-over-year trends in healthcare encounters and hospital charges across US children’s hospitals before and during the COVID-19 pandemic. We performed a retrospective analysis, comparing healthcare encounters and inflation-adjusted charges from 26 tertiary children’s hospitals reporting to the PROSPECT database from February 1 to June 30 in 2019 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic). All children’s hospitals experienced similar trends in healthcare encounters and charges during the study period. Inpatient bed-days, emergency department visits, and surgeries were lower by a median 36%, 65%, and 77%, respectively, per hospital by the week of April 15 (the nadir) in 2020 compared with 2019. Across the study period in 2020, children’s hospitals experienced a median decrease of $276 million in charges.
- Published
- 2021
40. Association of Race/Ethnicity and Social Determinants with Rehospitalization for Mental Health Conditions at Acute Care Children's Hospitals
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Whitney L. Browning, Gregory Plemmons, James W. Antoon, David P. Johnson, My-linh Ngo, Alison R. Carroll, Maya Neeley, Matthew Hall, Charlotte M. Brown, Sarah R. Hart, Swati B. Chokshi, Derek J. Williams, Heather Kreth, Alison Herndon, and Jakobi Johnson
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Social Determinants of Health ,Psychological intervention ,Ethnic group ,Patient Readmission ,Article ,Rurality ,Risk Factors ,Acute care ,medicine ,Humans ,Social determinants of health ,Child ,Retrospective Studies ,business.industry ,Mental Disorders ,Retrospective cohort study ,Health Status Disparities ,Hospitals, Pediatric ,Mental health ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Household income ,Female ,business ,Demography - Abstract
OBJECTIVE: To evaluate associations of race/ethnicity and social determinants with 90-day rehospitalization for mental health conditions to acute care non-psychiatric children’s hospitals. STUDY DESIGN: We conducted a retrospective cohort analysis of mental health hospitalizations for children aged 5 to 18 years from 2016-2018 at 32 freestanding U.S. children’s hospitals using the Children’s Hospital Association’s Pediatric Health Information System (PHIS) database to assess the association of race/ethnicity and social determinants (insurance payer, neighborhood median household income, and rurality of patient home location) with 90-day rehospitalization. Risk factors for rehospitalization were modeled using mixed-effects multivariable logistic regression. RESULTS: Among 23,556 index hospitalizations, there were 1382 mental health rehospitalizations (5.9%) within 90 days. Non-Hispanic Black children were 26% more likely to be rehospitalized than non-Hispanic White children (adjusted odds ratio [aOR] 1.26, 95% CI 1.08-1.48). Those with government insurance were 18% more likely to be rehospitalized than those with private insurance (aOR 1.18, 95% CI 1.04-1.34). In contrast, those living in a suburban location were 22% less likely to be rehospitalized than those living in an urban location (suburban: aOR 0.78, 95% CI 0.63-0.97). CONCLUSIONS: Non-Hispanic Black children and those with public insurance were at highest risk for 90-day rehospitalization, and risk was lower in those residing in suburban locations. Future work could focus on upstream interventions that will best attenuate social disparities to promote equity in pediatric mental healthcare.
- Published
- 2021
41. The COVID-19 Pandemic and Changes in Healthcare Utilization for Pediatric Respiratory and Nonrespiratory Illnesses in the United States
- Author
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Chén C. Kenyon, Cary Thurm, Samir S. Shah, Adam L. Hersh, James W. Antoon, Michael Bendel-Stenzel, Carlos G. Grijalva, Derek J. Williams, Todd A Florin, Ronald J. Teufel, Alicen B Spaulding, and Mario A Reyes
- Subjects
Male ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Adolescent ,Coronavirus disease 2019 (COVID-19) ,Leadership and Management ,Cross-sectional study ,Respiratory Tract Diseases ,Public health interventions ,Assessment and Diagnosis ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Epidemiology ,Pandemic ,medicine ,Humans ,030212 general & internal medicine ,Respiratory system ,Child ,Pandemics ,Care Planning ,SARS-CoV-2 ,business.industry ,Brief Report ,Health Policy ,Age Factors ,COVID-19 ,Infant ,General Medicine ,Patient Acceptance of Health Care ,Hospitals, Pediatric ,United States ,Cross-Sectional Studies ,Healthcare utilization ,Child, Preschool ,Emergency medicine ,Female ,Fundamentals and skills ,Emergency Service, Hospital ,business - Abstract
The impact of COVID-19 public health interventions on pediatric illnesses nationwide is unknown. We performed a multicenter, cross-sectional study of encounters at 44 children’s hospitals in the United States to assess changes in healthcare utilization during the pandemic. The COVID-19 pandemic was associated with substantial reductions in encounters for respiratory diseases; these large reductions were consistent across illness subgroups. Although encounters for nonrespiratory diseases decreased as well, reductions were more modest and varied by age. Encounters for respiratory diseases among adolescents declined to a lesser degree and returned to previous levels faster compared with those of younger children. Further study is needed to determine the contributions of decreased illness and changes in care-seeking behavior to this observed reduction.
- Published
- 2021
42. Pneumonia Severity in Children: Utility of Procalcitonin in Risk Stratification
- Author
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Rendie McHenry, Kathryn M. Edwards, Laura F. Sartori, Krow Ampofo, Derek J. Williams, Jakobi Johnson, Yuwei Zhu, Donald H. Arnold, Andrew T. Pavia, Carlos G. Grijalva, and Per H. Gesteland
- Subjects
Adult ,Calcitonin ,medicine.medical_specialty ,macromolecular substances ,Pediatrics ,Risk Assessment ,Procalcitonin ,03 medical and health sciences ,0302 clinical medicine ,Disease severity ,Interquartile range ,030225 pediatrics ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Child ,Research Articles ,business.industry ,musculoskeletal, neural, and ocular physiology ,General Medicine ,Pneumonia ,medicine.disease ,Community-Acquired Infections ,Bacterial etiology ,nervous system ,Pediatrics, Perinatology and Child Health ,Risk stratification ,business - Abstract
OBJECTIVES: To determine if serum procalcitonin, an indicator of bacterial etiology in pneumonia in all ages and a predictor of severe pneumonia in adults, is associated with disease severity in children with community-acquired pneumonia. METHODS: We prospectively enrolled children 2 months to RESULTS: The study included 488 children with pneumonia; 30 (6%) were classified as very severe, 106 (22%) as severe, 327 (67%) as moderate, and 25 (5%) as mild. Median procalcitonin in the very severe group was 5.06 (interquartile range [IQR] 0.90–16.83), 0.38 (IQR 0.11–2.11) in the severe group, 0.29 (IQR 0.09–1.90) in the moderate group, and 0.21 (IQR 0.12–1.2) in the mild group. Increasing procalcitonin was associated with increasing severity (range of aORs: 1.03–1.25) and increased LOS (range of aORs: 1.04–1.36). All comparisons were statistically significant. CONCLUSIONS: Higher procalcitonin was associated with increased severity and LOS. Procalcitonin may be useful in helping clinicians evaluate pneumonia severity.
- Published
- 2021
43. Quality of Care for Youth Hospitalized for Suicidal Ideation and Self-Harm
- Author
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William T. Basco, Courtney A. Gidengil, Naomi S. Bardach, Layla Parast, Maria T. Britto, Mark Brittan, Steven Yung, Anagha Alka Tolpadi, Sarah K. Connell, Rita Mangione-Smith, Derek J. Williams, Julie McGalliard, Kelly E. Wood, and Q. Burkhart
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Logistic regression ,Article ,Suicidal Ideation ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Medicine ,Humans ,030212 general & internal medicine ,Child ,Suicidal ideation ,Retrospective Studies ,business.industry ,Medical record ,Odds ratio ,Emergency department ,Mental health ,Confidence interval ,Patient Discharge ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Observational study ,Female ,medicine.symptom ,business ,Emergency Service, Hospital ,Self-Injurious Behavior - Abstract
Objective To examine performance on quality measures for pediatric inpatient suicidal ideation/self-harm care, and whether performance is associated with reutilization. Methods Retrospective observational 8 hospital study of patients [N = 1090] aged 5 to 17 years hospitalized for suicidal ideation/self-harm between 9/1/14 and 8/31/16. Two medical records-based quality measures assessing suicidal ideation/self-harm care were evaluated, one on counseling caregivers regarding restricting access to lethal means and the other on communication between inpatient and outpatient providers regarding the follow-up plan. Multivariable logistic regression assessed associations between quality measure scores and 1) hospital site, 2) patient demographics, and 3) 30-day emergency department return visits and inpatient readmissions. Results Medical record documentation revealed that, depending on hospital site, 17% to 98% of caregivers received lethal means restriction counseling (mean 70%); inpatient-to-outpatient provider communication was documented in 0% to 51% of cases (mean 16%). The odds of documenting receipt of lethal means restriction counseling was higher for caregivers of female patients compared to caregivers of male patients (adjusted odds ratio [aOR] 1.51, 95% confidence interval [CI], 1.07–2.14). The odds of documenting inpatient-to-outpatient provider follow-up plan communication was lower for Black patients compared to White patients (aOR 0.45, 95% CI, 0.24–0.84). All-cause 30-day readmission was lower for patients with documented caregiver receipt of lethal means restriction counseling (aOR 0.48, 95% CI, 0.28–0.83). Conclusions This study revealed disparities and deficits in the quality of care received by youth with suicidal ideation/self-harm. Providing caregivers lethal means restriction counseling prior to discharge may help to prevent readmission.
- Published
- 2021
44. Prevalence of Clinically Significant Drug-Drug Interactions Across US Children’s Hospitals
- Author
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My-linh Ngo, Matthew Hall, Carlos G. Grijalva, Patricia A. Frost, David P. Johnson, Derek J. Williams, Alison Herndon, Katherine L. Freundlich, James A. Feinstein, Justine C. Stassun, Whitney L. Browning, James W. Antoon, Alison R. Carroll, Swati B. Chokshi, and Charlotte M. Brown
- Subjects
Adult ,Male ,Drug ,medicine.medical_specialty ,Adolescent ,Drug-Related Side Effects and Adverse Reactions ,media_common.quotation_subject ,Psychological intervention ,MEDLINE ,Drug Prescriptions ,Risk Assessment ,Odds ,Cohort Studies ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,Drug Interactions ,Child ,Adverse effect ,Retrospective Studies ,media_common ,Medication use ,business.industry ,Infant ,Retrospective cohort study ,Hospitals, Pediatric ,United States ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Female ,business ,Pediatric population - Abstract
BACKGROUND: Little is known about the prescribing of medications with potential drug-drug interactions (DDIs) in the pediatric population. The objective of this study was to determine the prevalence and variation of prescribing medications with clinically significant DDIs across children’s hospitals in the United States. METHODS: We performed a retrospective cohort study of patients RESULTS: Across 52 children’s hospitals, 47 414 (2.0%) hospitalizations included exposure to a DDI pairing (34.9 per 1000 patient-days) during the study period. One-quarter of pairings were considered contraindicated (risk grade X). After adjusting for hospital and clinical factors, there was wide variation in the percentage of DDI prescribing across hospitals, ranging from 1.05% to 4.92%. There was also substantial hospital-level variation of exposures to individual drug pairings. Increasing age, number of complex chronic conditions, length of stay, and surgical encounters were independently associated with an increased odds of DDI exposure. CONCLUSIONS: Patients hospitalized at US children’s hospitals are frequently exposed to medications with clinically significant DDIs. Exposure risk varied substantially across hospitals. Further study is needed to determine the rate of adverse events due to DDI exposures and factors amenable for interventions promoting safer medication use.
- Published
- 2020
45. Short- Versus Prolonged-Duration Antibiotics for Outpatient Pneumonia in Children
- Author
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Lilliam Ambroggio, Samir S. Shah, Adam L. Hersh, Carlos G. Grijalva, Mark I. Neuman, Anne J. Blaschke, Derek J. Williams, Susan C. Lipsett, Jeffrey S. Gerber, Thomas V. Brogan, Matthew Hall, and Daniel J. Shapiro
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,Antibiotics ,Administration, Oral ,Logistic regression ,Drug Administration Schedule ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Internal medicine ,Acute care ,medicine ,Ambulatory Care ,Humans ,030212 general & internal medicine ,Medical prescription ,Child ,Retrospective Studies ,business.industry ,Infant ,Retrospective cohort study ,Pneumonia ,medicine.disease ,Anti-Bacterial Agents ,Community-Acquired Infections ,Logistic Models ,Treatment Outcome ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Ambulatory ,Female ,business ,Medicaid ,Follow-Up Studies - Abstract
Objective To identify practice patterns in the duration of prescribed antibiotics for the treatment of ambulatory children with community-acquired pneumonia (CAP) and to compare the frequency of adverse clinical outcomes between children prescribed short-vs prolonged-duration antibiotics. Study design We performed a retrospective cohort study from 2010-2016 using the IBM Watson MarketScan Medicaid Database, a claims database of publicly insured patients from 11 states. We included children 1-18 years old with outpatient CAP who filled a prescription for oral antibiotics (n = 121 846 encounters). We used multivariable logistic regression to determine associations between the duration of prescribed antibiotics (5-9 days vs 10-14 days) and subsequent hospitalizations, new antibiotic prescriptions, and acute care visits. Outcomes were measured during the 14 days following the end of the dispensed antibiotic course. Results The most commonly prescribed duration of antibiotics was 10 days (82.8% of prescriptions), and 10.5% of patients received short-duration therapy. During the follow-up period, 0.2% of patients were hospitalized, 6.2% filled a new antibiotic prescription, and 5.1% had an acute care visit. Compared with the prolonged-duration group, the aORs for hospitalization, new antibiotic prescriptions, and acute care visits in the short-duration group were 1.16 (95% CI 0.80-1.66), 0.93 (95% CI 0.85-1.01), and 1.06 (95% CI 0.98-1.15), respectively. Conclusions Most children treated for CAP as outpatients are prescribed at least 10 days of antibiotic therapy. Among pediatric outpatients with CAP, no significant differences were found in rates of adverse clinical outcomes between patients prescribed short-vs prolonged-duration antibiotics.
- Published
- 2020
46. Antibiotic Choice and Clinical Outcomes in Ambulatory Children with Community-Acquired Pneumonia
- Author
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Carlos G. Grijalva, Anne J. Blaschke, Samir S. Shah, Adam L. Hersh, Matthew Hall, Derek J. Williams, Jeffrey S. Gerber, Susan C. Lipsett, Lilliam Ambroggio, Mark I. Neuman, and Thomas V. Brogan
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,medicine.drug_class ,medicine.medical_treatment ,Antibiotics ,Drug Prescriptions ,Article ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Community-acquired pneumonia ,030225 pediatrics ,Internal medicine ,medicine ,Ambulatory Care ,Pneumonia, Bacterial ,Humans ,030212 general & internal medicine ,Child ,Retrospective Studies ,Mechanical ventilation ,business.industry ,Infant ,Retrospective cohort study ,Amoxicillin ,medicine.disease ,Anti-Bacterial Agents ,Community-Acquired Infections ,Pneumonia ,Treatment Outcome ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Ambulatory ,Female ,Outcomes research ,business ,medicine.drug - Abstract
OBJECTIVES: To describe antibiotic prescribing patterns in ambulatory children with community-acquired pneumonia and to assess the relationship between antibiotic selection and clinical outcomes. STUDY DESIGN: This was a retrospective cohort study of ambulatory Medicaid-enrolled children 0-18 years of age diagnosed with community-acquired pneumonia from 2010 to 2016. The exposure was antibiotic class: narrow-spectrum (aminopenicillins), broad-spectrum (amoxicillin/clavulanate and cephalosporins), macrolide monotherapy, macrolides with narrow-spectrum antibiotics, or macrolides with broad-spectrum antibiotics. The associations between antibiotic selection and the outcomes of subsequent hospitalization and development of severe pneumonia (chest drainage procedure, intensive care admission, mechanical ventilation) were assessed, controlling for measures of illness severity. RESULTS: Among 252 177 outpatient pneumonia visits, macrolide monotherapy was used in 43.2%, narrow-spectrum antibiotics in 26.1%, and broad-spectrum antibiotics in 24.7%. A total of 1488 children (0.59%) were subsequently hospitalized and 117 (0.05%) developed severe pneumonia. Compared with children receiving narrow-spectrum antibiotics, the odds of subsequent hospitalization were higher in children receiving broad-spectrum antibiotics (aOR, 1.34; 95% CI, 1.17-1.52) and lower in children receiving macrolide monotherapy (aOR, 0.64; 95% CI, 0.55-0.73) and macrolides with narrow-spectrum antibiotics (aOR, 0.62; 95% CI, 0.39-0.97). Children receiving macrolide monotherapy had lower odds of developing severe pneumonia than children receiving narrow-spectrum antibiotics (aOR, 0.56; 95% CI, 0.33-0.93). However, the absolute risk difference was
- Published
- 2020
47. Parainfluenza Virus Types 1-3 Infections Among Children and Adults Hospitalized With Community-acquired Pneumonia
- Author
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Derek J. Williams, Evan J. Anderson, Andrew T. Pavia, Carlos G. Grijalva, Richard G. Wunderink, Sandra R. Arnold, Yuwei Zhu, Wesley H. Self, Leigh M Howard, Seema Jain, Kathryn M. Edwards, Jonathan A. McCullers, and Krow Ampofo
- Subjects
Microbiology (medical) ,Serotype ,Adult ,medicine.medical_specialty ,Population ,Pneumonia, Viral ,Serology ,Community-acquired pneumonia ,Parainfluenza virus ,Internal medicine ,medicine ,Humans ,education ,Child ,Online Only Articles ,Respiratory Tract Infections ,education.field_of_study ,Paramyxoviridae Infections ,Respiratory tract infections ,business.industry ,Bacterial pneumonia ,Infant ,medicine.disease ,respiratory tract diseases ,Parainfluenza Virus 1, Human ,Community-Acquired Infections ,Hospitalization ,Pneumonia ,Infectious Diseases ,business - Abstract
BackgroundParainfluenza virus (PIV) is a leading cause of lower respiratory tract infections. Although there are several distinct PIV serotypes, few studies have compared the clinical characteristics and severity of infection among the individual PIV serotypes and between PIV and other pathogens in patients with community-acquired pneumonia.MethodsWe conducted active population-based surveillance for radiographically confirmed community-acquired pneumonia hospitalizations among children and adults in 8 US hospitals with systematic collection of clinical data and respiratory, blood, and serological specimens for pathogen detection. We compared clinical features of PIV-associated pneumonia among individual serotypes 1, 2, and 3 and among all PIV infections with other viral, atypical, and bacterial pneumonias. We also compared in-hospital disease severity among groups employing an ordinal scale (mild, moderate, severe) using multivariable proportional odds regression.ResultsPIV was more commonly detected in children (155/2354; 6.6%) than in adults (66/2297; 2.9%) (P < .001). Other pathogens were commonly co-detected among PIV cases (110/221; 50%). Clinical features of PIV-1, PIV-2, and PIV-3 infections were similar to one another in both children and adults with pneumonia. In multivariable analysis, children with PIV-associated pneumonia exhibited similar severity to children with other nonbacterial pneumonia, whereas children with bacterial pneumonia exhibited increased severity (odds ratio, 8.42; 95% confidence interval, 1.88–37.80). In adults, PIV-associated pneumonia exhibited similar severity to other pneumonia pathogens.ConclusionsClinical features did not distinguish among infection with individual PIV serotypes in patients hospitalized with community-acquired pneumonia. However, in children, PIV pneumonia was less severe than bacterial pneumonia.
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- 2020
48. Considerable variability in antibiotic use among US children's hospitals in 2017-2018
- Author
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Hannah Griffith, Cary Thurm, Derek J. Williams, Carlos G. Grijalva, Leigh M Howard, Ritu Banerjee, and Keerti Dantuluri
- Subjects
Microbiology (medical) ,Male ,medicine.medical_specialty ,Adolescent ,Epidemiology ,medicine.drug_class ,Pediatric health ,Antibiotics ,Article ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,030212 general & internal medicine ,Antibiotic use ,Child ,business.industry ,Infant, Newborn ,Infant ,Hospitals, Pediatric ,Drug Utilization ,United States ,Anti-Bacterial Agents ,Infectious Diseases ,Cross-Sectional Studies ,Child, Preschool ,Emergency medicine ,Antibiotic Stewardship ,Female ,Seasons ,business ,Surgical patients - Abstract
Objective:To characterize the prevalence of and seasonal and regional variation in inpatient antibiotic use among hospitalized US children in 2017–2018.Design:We conducted a cross-sectional examination of hospitalized children. The assessments were conducted on a single day in spring (May 3, 2017), summer (August 2, 2017), fall (October 25, 2017), and winter (January 31, 2018). The main outcome of interest was receipt of an antibiotic on the study day.Setting:The study included 51 freestanding US children’s hospitals that participate in the Pediatric Health Information System (PHIS).Patients:This study included all patients Results:Of 52,769 total hospitalized children, 19,174 (36.3%) received antibiotics on the study day and 6,575 of these (12.5%) received broad-spectrum antibiotics. The overall prevalence of antibiotic use varied across hospitals from 22.3% to 51.9%. Antibiotic use prevalence was 29.2% among medical patients and 47.7% among surgical patients. Although there was no significant seasonal variation in antibiotic use prevalence, regional prevalence varied, ranging from 32.7% in the Midwest to 40.2% in the West (P< .001). Among units, pediatric intensive care unit patients had the highest prevalence of both overall and broad-spectrum antibiotic use at 58.3% and 26.6%, respectively (P< .001).Conclusions:On any given day in a national network of children’s hospitals, more than one-third of hospitalized children received an antibiotic, and 1 in 8 received a broad-spectrum antibiotic. Variation across hospitals, setting and regions identifies potential opportunities for enhanced antibiotic stewardship activities.
- Published
- 2020
49. Clinical Progress Note: Procalcitonin in the Management of Pediatric Lower Respiratory Tract Infection
- Author
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Laura F. Sartori, Derek J. Williams, and Sophie E Katz
- Subjects
medicine.medical_specialty ,Leadership and Management ,MEDLINE ,Assessment and Diagnosis ,Procalcitonin ,03 medical and health sciences ,0302 clinical medicine ,Lower respiratory tract infection ,parasitic diseases ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Child ,Care Planning ,Respiratory Tract Infections ,Progress note ,0303 health sciences ,030306 microbiology ,business.industry ,Extramural ,Health Policy ,General Medicine ,bacterial infections and mycoses ,medicine.disease ,respiratory tract diseases ,Anti-Bacterial Agents ,Progress Notes ,Fundamentals and skills ,business ,hormones, hormone substitutes, and hormone antagonists ,Biomarkers - Abstract
Procalcitonin (PCT) is a biomarker that has shown promise to identify bacterial etiology in acute infections, including bacterial lower respiratory tract infection (LRTI). In 2017, the United States Food and Drug Administration (FDA) approved the use of PCT as a diagnostic aid to guide the decisions around antibiotic therapy in acute LRTI.1 Although most of the data supporting the use of PCT for LRTI stems from adult studies, the high disease burden, predominance of viral etiologies, and frequent diagnostic uncertainty resulting in antibiotic overuse make pediatric LRTI an ideal target for the use of PCT as a diagnostic aid. This review evaluates and summarizes the current evidence regarding the role of PCT in the clinical care of pediatric LRTI, including its use in guiding antibiotic use and prognosticating disease severity.
- Published
- 2019
50. Funky Rash in Nashville
- Author
-
Michele M. Walsh, Donald H. Arnold, Laura F. Sartori, Derek J. Williams, Cristina Estrada, Saralyn R. Williams, and Jaime Kaye Otillio
- Subjects
Abdominal pain ,medicine.medical_specialty ,business.industry ,General surgery ,education ,Emergency department ,medicine.disease ,Factitious disorder ,Rash ,Hematochezia ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Pediatric emergency medicine ,030225 pediatrics ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,medicine ,Etiology ,Munchausen syndrome ,medicine.symptom ,business - Abstract
A 17-year-old male adolescent presents to the emergency department with recurrent ulcerative skin lesions of the extremities, as well as weight loss, hematochezia, and postprandial abdominal pain. As diagnosis and treatment of dermatologic lesions are mainstays of pediatric emergency medicine, his initial presentation and broad differential provide valuable teaching lessons regarding the etiology and workup of ulcerative skin lesions. Following multiple long hospitalizations and extensive testing, the ultimate diagnosis was eventually revealed through attention to subtle details in the patient's history and presentation. A keen eye for similar presentations has the potential to provide future patients with less extensive workups, minimizing invasive patient testing and saving significant health care dollars.
- Published
- 2018
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