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3. Access to Critical Health Information for Children During Emergencies: Emergency Information Forms and Beyond

Author

Dietrich, Ann M., Chairperson, Alade, Kiyetta H., Amato, Christopher S., Atanelov, Zaza, Auerbach, Marc, Barata, Isabel A., Benjamin, Lee S., Berg, Kathleen T., Brown, Kathleen, Chang, Cindy, Chow, Jessica, Chumpitazi, Corrie E., Claudius, Ilene A., Easter, Joshua, Foster, Ashley, Fox, Sean M., Gausche-Hill, Marianne, Gerardi, Michael J., Goodloe, Jeffrey M., Heniff, Melanie, Homme, James (Jim) L., Ishimine, Paul T., John, Susan D., Joseph, Madeline M., Lam, Samuel Hiu-Fung, Lawson, Simone L., Lee, Moon O., Li, Joyce, Lin, Sophia D., Martini, Dyllon Ivy, Mellick, Larry Bruce, Mendez, Donna, Petrack, Emory M., Rice, Lauren, Rose, Emily A., Ruttan, Timothy, Saidinejad, Mohsen, Santillanes, Genevieve, Simpson, Joelle N., Sivasankar, Shyam M., Slubowski, Daniel, Sorrentino, Annalise, Stoner, Michael J., Sulton, Carmen D., Valente, Jonathan H., Vora, Samreen, Wall, Jessica J., Wallin, Dina, Walls, Theresa A., Waseem, Muhammad, Woolridge, Dale P., Callahan, James M., Baldwin, Steve, Bodnar, Chelsea, Fuchs, Susan, Krug, Steven, Lightfoot, Cynthiana, Raskas, Mordechai, and Weinberg, Stuart

Published
2023
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5. A National Approach to Pediatric Sepsis Surveillance

Author

Hsu, Heather E, Abanyie, Francisca, Agus, Michael SD, Balamuth, Fran, Brady, Patrick W, Brilli, Richard J, Carcillo, Joseph A, Dantes, Raymund, Epstein, Lauren, Fiore, Anthony E, Gerber, Jeffrey S, Gokhale, Runa H, Joyner, Benny L, Kissoon, Niranjan, Klompas, Michael, Lee, Grace M, Macias, Charles G, Puopolo, Karen M, Sulton, Carmen D, Weiss, Scott L, and Rhee, Chanu

Subjects
Hematology, Pediatric, Clinical Research, Prevention, Sepsis, Patient Safety, Pediatric Research Initiative, Infectious Diseases, Infection, Inflammatory and immune system, Good Health and Well Being, Age Distribution, Child, Cost of Illness, Electronic Health Records, Humans, Incidence, Infant, Population Surveillance, United States, Medical and Health Sciences, Psychology and Cognitive Sciences, Pediatrics
Abstract

Pediatric sepsis is a major public health concern, and robust surveillance tools are needed to characterize its incidence, outcomes, and trends. The increasing use of electronic health records (EHRs) in the United States creates an opportunity to conduct reliable, pragmatic, and generalizable population-level surveillance using routinely collected clinical data rather than administrative claims or resource-intensive chart review. In 2015, the US Centers for Disease Control and Prevention recruited sepsis investigators and representatives of key professional societies to develop an approach to adult sepsis surveillance using clinical data recorded in EHRs. This led to the creation of the adult sepsis event definition, which was used to estimate the national burden of sepsis in adults and has been adapted into a tool kit to facilitate widespread implementation by hospitals. In July 2018, the Centers for Disease Control and Prevention convened a new multidisciplinary pediatric working group to tailor an EHR-based national sepsis surveillance approach to infants and children. Here, we describe the challenges specific to pediatric sepsis surveillance, including evolving clinical definitions of sepsis, accommodation of age-dependent physiologic differences, identifying appropriate EHR markers of infection and organ dysfunction among infants and children, and the need to account for children with medical complexity and the growing regionalization of pediatric care. We propose a preliminary pediatric sepsis event surveillance definition and outline next steps for refining and validating these criteria so that they may be used to estimate the national burden of pediatric sepsis and support site-specific surveillance to complement ongoing initiatives to improve sepsis prevention, recognition, and treatment.

Published
2019

11. The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies

Author

Saidinejad, Mohsen, primary, Duffy, Susan, additional, Wallin, Dina, additional, Hoffmann, Jennifer A., additional, Joseph, Madeline, additional, Schieferle Uhlenbrock, Jennifer, additional, Brown, Kathleen, additional, Waseem, Muhammad, additional, Snow, Sally K., additional, Andrew, Madeline, additional, Kuo, Alice A., additional, Sulton, Carmen, additional, Chun, Thomas, additional, Lee, Lois K., additional, Conners, Gregory P., additional, Callahan, James, additional, Gross, Toni, additional, Lee, Lois, additional, Mack, Elizabeth, additional, Marin, Jennifer, additional, Mazor, Suzan, additional, Paul, Ronald, additional, Timm, Nathan, additional, Dietrich, Ann M., additional, Alade, Kiyetta H., additional, Amato, Christopher S., additional, Atanelov, Zaza, additional, Auerbach, Marc, additional, Barata, Isabel A., additional, Benjamin, Lee S., additional, Berg, Kathleen T., additional, Chang, Cindy, additional, Chow, Jessica, additional, Chumpitazi, Corrie E., additional, Claudius, Ilene A., additional, Easter, Joshua, additional, Foster, Ashley, additional, Fox, Sean M., additional, Gausche-Hill, Marianne, additional, Gerardi, Michael J., additional, Goodloe, Jeffrey M., additional, Heniff, Melanie, additional, Homme, James (Jim) L., additional, Ishimine, Paul T., additional, John, Susan D., additional, Joseph, Madeline M., additional, Lam, Samuel Hiu-Fung, additional, Lawson, Simone L., additional, Lee, Moon O., additional, Li, Joyce, additional, Lin, Sophia D., additional, Martini, Dyllon Ivy, additional, Mellick, Larry Bruce, additional, Mendez, Donna, additional, Petrack, Emory M., additional, Rice, Lauren, additional, Rose, Emily A., additional, Ruttan, Timothy, additional, Saidinejad, Mohsen, additional, Santillanes, Genevieve, additional, Simpson, Joelle N., additional, Sivasankar, Shyam M., additional, Slubowski, Daniel, additional, Sorrentino, Annalise, additional, Stoner, Michael J., additional, Sulton, Carmen D., additional, Valente, Jonathan H., additional, Vora, Samreen, additional, Wall, Jessica J., additional, Walls, Theresa A., additional, Woolridge, Dale P., additional, Brandt, Cam, additional, Kult, Krisi M., additional, Milici, Justin J., additional, Nelson, Nicholas A., additional, Redlo, Michele A., additional, Curtis Cooper, Maureen R., additional, Redlo, Michele, additional, Kult, Krisi, additional, Logee, Katherine, additional, Bryant, Dixie Elizabeth, additional, Cooper, Maureen Curtis, additional, and Cline, Kristen, additional

Published
2023
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16. Access to Critical Health Information for Children During Emergencies: Emergency Information Forms and Beyond

Author

Callahan, James M., Baldwin, Steve, Bodnar, Chelsea, Fuchs, Susan, Krug, Steven, Lightfoot, Cynthiana, Raskas, Mordechai, Weinberg, Stuart, Dietrich, Ann M., Chairperson, Alade, Kiyetta H., Amato, Christopher S., Atanelov, Zaza, Auerbach, Marc, Barata, Isabel A., Benjamin, Lee S., Berg, Kathleen T., Brown, Kathleen, Chang, Cindy, Chow, Jessica, Chumpitazi, Corrie E., Claudius, Ilene A., Easter, Joshua, Foster, Ashley, Fox, Sean M., Gausche-Hill, Marianne, Gerardi, Michael J., Goodloe, Jeffrey M., Heniff, Melanie, Homme, James (Jim) L., Ishimine, Paul T., John, Susan D., Joseph, Madeline M., Lam, Samuel Hiu-Fung, Lawson, Simone L., Lee, Moon O., Li, Joyce, Lin, Sophia D., Martini, Dyllon Ivy, Mellick, Larry Bruce, Mendez, Donna, Petrack, Emory M., Rice, Lauren, Rose, Emily A., Ruttan, Timothy, Saidinejad, Mohsen, Santillanes, Genevieve, Simpson, Joelle N., Sivasankar, Shyam M., Slubowski, Daniel, Sorrentino, Annalise, Stoner, Michael J., Sulton, Carmen D., Valente, Jonathan H., Vora, Samreen, Wall, Jessica J., Wallin, Dina, Walls, Theresa A., Waseem, Muhammad, and Woolridge, Dale P.

Published
2023
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17. Access to Optimal Emergency Care for Children

Author

Brown, Kathleen M., primary, Ackerman, Alice D., additional, Ruttan, Timothy K., additional, Snow, Sally K., additional, Conners, Gregory P., additional, Callahan, James, additional, Gross, Toni, additional, Joseph, Madeline, additional, Lee, Lois, additional, Mack, Elizabeth, additional, Marin, Jennifer, additional, Mazor, Suzan, additional, Paul, Ronald, additional, Timm, Nathan, additional, Dietrich, Ann M., additional, Alade, Kiyetta H., additional, Amato, Christopher S., additional, Atanelov, Zaza, additional, Auerbach, Marc, additional, Barata, Isabel A., additional, Benjamin, Lee S., additional, Berg, Kathleen T., additional, Brown, Kathleen, additional, Chang, Cindy, additional, Chow, Jessica, additional, Chumpitazi, Corrie E., additional, Claudius, Ilene A., additional, Easter, Joshua, additional, Foster, Ashley, additional, Fox, Sean M., additional, Gausche-Hill, Marianne, additional, Gerardi, Michael J., additional, Goodloe, Jeffrey M., additional, Heniff, Melanie, additional, Homme, James (Jim) L., additional, Ishimine, Paul T., additional, John, Susan D., additional, Joseph, Madeline M., additional, Lam, Samuel Hiu-Fung, additional, Lawson, Simone L., additional, Lee, Moon O., additional, Li, Joyce, additional, Lin, Sophia D., additional, Martini, Dyllon Ivy, additional, Mellick, Larry Bruce, additional, Mendez, Donna, additional, Petrack, Emory M., additional, Rice, Lauren, additional, Rose, Emily A., additional, Ruttan, Timothy, additional, Saidinejad, Mohsen, additional, Santillanes, Genevieve, additional, Simpson, Joelle N., additional, Sivasankar, Shyam M., additional, Slubowski, Daniel, additional, Sorrentino, Annalise, additional, Stoner, Michael J., additional, Sulton, Carmen D., additional, Valente, Jonathan H., additional, Vora, Samreen, additional, Wall, Jessica J., additional, Wallin, Dina, additional, Walls, Theresa A., additional, Waseem, Muhammad, additional, Woolridge, Dale P., additional, Brandt, Cam, additional, Kult, Krisi M., additional, Milici, Justin J., additional, Nelson, Nicholas A., additional, Redlo, Michele A., additional, Curtis Cooper, Maureen R., additional, Redlo, Michele, additional, Kult, Krisi, additional, Logee, Katherine, additional, Bryant, Dixie Elizabeth, additional, Cooper, Maureen Curtis, additional, and Cline, Kristen, additional

Published
2021
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26. Access to Optimal Emergency Care for Children

Author

Conners, Gregory P., Callahan, James, Gross, Toni, Joseph, Madeline, Lee, Lois, Mack, Elizabeth, Marin, Jennifer, Mazor, Suzan, Paul, Ronald, Timm, Nathan, Dietrich, Ann M., Alade, Kiyetta H., Amato, Christopher S., Atanelov, Zaza, Auerbach, Marc, Barata, Isabel A., Benjamin, Lee S., Berg, Kathleen T., Brown, Kathleen, Chang, Cindy, Chow, Jessica, Chumpitazi, Corrie E., Claudius, Ilene A., Easter, Joshua, Foster, Ashley, Fox, Sean M., Gausche-Hill, Marianne, Gerardi, Michael J., Goodloe, Jeffrey M., Heniff, Melanie, Homme, James (Jim) L., Ishimine, Paul T., John, Susan D., Joseph, Madeline M., Lam, Samuel Hiu-Fung, Lawson, Simone L., Lee, Moon O., Li, Joyce, Lin, Sophia D., Martini, Dyllon Ivy, Mellick, Larry Bruce, Mendez, Donna, Petrack, Emory M., Rice, Lauren, Rose, Emily A., Ruttan, Timothy, Saidinejad, Mohsen, Santillanes, Genevieve, Simpson, Joelle N., Sivasankar, Shyam M., Slubowski, Daniel, Sorrentino, Annalise, Stoner, Michael J., Sulton, Carmen D., Valente, Jonathan H., Vora, Samreen, Wall, Jessica J., Wallin, Dina, Walls, Theresa A., Waseem, Muhammad, Woolridge, Dale P., Brandt, Cam, Kult, Krisi M., Milici, Justin J., Nelson, Nicholas A., Redlo, Michele A., Curtis Cooper, Maureen R., Redlo, Michele, Kult, Krisi, Logee, Katherine, Bryant, Dixie Elizabeth, Cooper, Maureen Curtis, Cline, Kristen, Brown, Kathleen M., Ackerman, Alice D., Ruttan, Timothy K., and Snow, Sally K.

Published
2021
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29. The Pediatric Airway and Rapid Sequence Intubation in Trauma.

Author

Sulton, Carmen D. and Taylor, Taryn R.

Subjects
*PNEUMOTHORAX, *TRAUMATOLOGY diagnosis, *LARYNX, *OROPHARYNX, *ACTIVE oxygen in the body, *AIRWAY (Anatomy), *ANESTHESIA, *ETOMIDATE, *KETAMINE, *LARYNGOSCOPY, *OXIMETRY, *PEDIATRICS, *RESPIRATORY measurements, *TRACHEA intubation, *PULSE oximeters, *EQUIPMENT & supplies, *RESPIRATORY aspiration, *SUCCINYLCHOLINE, *ANATOMY, *DIAGNOSIS
Published
2017

30. 1165

Author

Sulton, Carmen, primary, Dugan, Mark, additional, Little, Wendalyn, additional, and Hebbar, Kiran, additional

Published
2014
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31. 659

Author

Sulton, Carmen, primary, Hebbar, Kiran, additional, McCracken, Courtney, additional, Simon, Harold, additional, Reynolds, Jason, additional, Cravero, Joseph, additional, and Kamat, Pradip, additional

Published
2014
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33. The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies.

Author

Saidinejad M, Duffy S, Wallin D, Hoffmann JA, Joseph MM, Uhlenbrock JS, Brown K, Waseem M, Snow S, Andrew M, Kuo AA, Sulton C, Chun T, and Lee LK

Subjects
Child, Humans, Adolescent, Emergencies, Emergency Service, Hospital, Mental Health, Mental Disorders diagnosis, Mental Disorders therapy, Emergency Medical Services
Abstract

Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are referred to the ED for evaluation of a broad spectrum of MBH emergencies, from depression and suicidality to disruptive and aggressive behavior. However, challenges in providing optimal care to these patients include lack of personnel, capacity, and infrastructure; challenges with timely access to a mental health professional; the nature of a busy ED environment; and paucity of outpatient post-ED discharge resources. These factors contribute to prolonged ED stays and boarding, which negatively affect patient care and ED operations. Strategies to improve care for MBH emergencies, including systems-level coordination of care, are therefore essential. The goal of this policy statement and its companion technical report is to highlight strategies, resources, and recommendations for improving emergency care delivery for pediatric MBH., (Copyright © 2023 by the American Academy of Pediatrics.)

Published
2023
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34. Sedation and Analgesia for Reduction of Pediatric Ileocolic Intussusception.

Author

Poonai N, Cohen DM, MacDowell D, Mistry RD, Mintegi S, Craig S, Roland D, Miller M, Shavit I, Wang Y, Nager A, Heyming T, Burns R, Trehan I, Lipshaw M, Sulton C, Li J, Ojo A, Kelly S, Thornton M, Caperell K, Amoni I, Abrams A, Duong M, Wassem M, Davis A, Gravel J, Doyon Trottier E, Bar Am N, Thompson G, Sabhaney V, Meckler G, Jain R, Ali S, Bressan S, Zangardi T, Villa G, Giacalone M, Seiler M, Sahyoun C, Romano F, Bognar Z, Hajosi-Kalcakosz S, Amir L, Hachimi-Idrissi S, Pucuka Z, Zviedre A, Zeltina E, Phillips N, Borland M, O'Brien S, Marchant J, Kochar A, George S, Pennington V, Lyttle M, Browning J, McLoughlin A, Hartshorn S, Urooj C, Johnston L, Walton E, Subrahmanyam Puthucode D, Peacock P, Conroy J, Marañon R, Garcia S, Cahís N, Cámara-Otegui A, Gomez A, Carbonero M, Angelats-Romero C, Yock-Corrales A, Hualde G, Spigariol F, Donas A, Gübeli Linné C, Rocchi A, Pedrazzini A, Cozzi G, Barbi D, Baggio L, La Fauci G, Mauro A, Steimle M, Buonsenso D, Ugalde I, Nieva G, Harper C, Sforzi I, and Jain S

Subjects
Male, Child, Humans, Adolescent, Female, Analgesics, Opioid therapeutic use, Cross-Sectional Studies, Intussusception complications, Intestinal Perforation etiology, Analgesia adverse effects
Abstract

Importance: Ileocolic intussusception is an important cause of intestinal obstruction in children. Reduction of ileocolic intussusception using air or fluid enema is the standard of care. This likely distressing procedure is usually performed without sedation or analgesia, but practice variation exists., Objective: To characterize the prevalence of opioid analgesia and sedation and assess their association with intestinal perforation and failed reduction., Design, Setting, and Participants: This cross-sectional study reviewed medical records of children aged 4 to 48 months with attempted reduction of ileocolic intussusception at 86 pediatric tertiary care institutions in 14 countries from January 2017 to December 2019. Of 3555 eligible medical records, 352 were excluded, and 3203 medical records were eligible. Data were analyzed in August 2022., Exposures: Reduction of ileocolic intussusception., Main Outcomes and Measures: The primary outcomes were opioid analgesia within 120 minutes of reduction based on the therapeutic window of IV morphine and sedation immediately before reduction of intussusception., Results: We included 3203 patients (median [IQR] age, 17 [9-27] months; 2054 of 3203 [64.1%] males). Opioid use was documented in 395 of 3134 patients (12.6%), sedation 334 of 3161 patients (10.6%), and opioids plus sedation in 178 of 3134 patients (5.7%). Perforation was uncommon and occurred in 13 of 3203 patients (0.4%). In the unadjusted analysis, opioids plus sedation (odds ratio [OR], 5.92; 95% CI, 1.28-27.42; P = .02) and a greater number of reduction attempts (OR, 1.48; 95% CI, 1.03-2.11; P = .03) were significantly associated with perforation. In the adjusted analysis, neither of these covariates remained significant. Reductions were successful in 2700 of 3184 attempts (84.8%). In the unadjusted analysis, younger age, no pain assessment at triage, opioids, longer duration of symptoms, hydrostatic enema, and gastrointestinal anomaly were significantly associated with failed reduction. In the adjusted analysis, only younger age (OR, 1.05 per month; 95% CI, 1.03-1.06 per month; P < .001), shorter duration of symptoms (OR, 0.96 per hour; 95% CI, 0.94-0.99 per hour; P = .002), and gastrointestinal anomaly (OR, 6.50; 95% CI, 2.04-20.64; P = .002) remained significant., Conclusions and Relevance: This cross-sectional study of pediatric ileocolic intussusception found that more than two-thirds of patients received neither analgesia nor sedation. Neither was associated with intestinal perforation or failed reduction, challenging the widespread practice of withholding analgesia and sedation for reduction of ileocolic intussusception in children.

Published
2023
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