Retrospective Analysis of a Pediatric Vascular Access Program and Clinical Outcomes

Abstract Background: The specialty of pediatric vascular access has grown rapidly during the past 5 years across the United States. The majority of children's hospitals have nurse-led vascular access teams that are providing comprehensive services, including the placement of peripherally inserted central catheters. A children's hospital in the southeastern United States conducted an Internal Review Board approved, retrospective analysis of 669 patients who had a peripherally inserted central catheter placed. Objective: The objective was to have a better understanding of the program and clinical outcomes as well as identify areas for improvement. Methods: A data collection tool was developed to review the medical records of patients receiving a peripherally inserted central catheter from January 2009 through June 2011. Variables of interest included patient age, admitting diagnosis, intended therapy, procedure location, sedation type and usage, procedure success, insertion attempts, vessel selected, catheter size and type, catheter tip location, reason for discontinuation, and infection. The data was collected and analyzed by a nurse researcher from the University of South Florida. Results: Using the Modified Seldinger Technique and ultrasound, the team inserted a full line of polyurethane catheters, including computed tomography-injectable catheters, with an insertion success rate of 94%. We identified a significant reduction in our hospital's infection rate—from 9.12 per 1,000 catheter line days to 2.0 per 1,000 catheter line days—during the first year and a half of the program. The use of sedation and anesthesia was significantly reduced, with 49% of patients receiving an oral anxiolytic dose of midazolam and the integration of certified child life specialists into the procedure. Conclusions: Pediatric vascular access is a rapidly growing specialty in nursing. Nurse-led vascular access teams have become commonplace in children's hospitals throughout the United States. Although the specialty has grown rapidly during the past 5 years, there is a need for data sharing to contribute to the knowledge base of pediatric vascular access.

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THE EPIDEMIOLOGY OF PEDIATRIC MENISCAL ALLOGRAFT TRANSPLANTATION IN THE UNITED STATES

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00040 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0004

Author(s):

Haley E. Smith ◽

Madeline M. Lyons ◽

Neeraj M. Patel

Keyword(s):

United States ◽

Pediatric Population ◽

The United States ◽

National Database ◽

Control Group ◽

Meniscal Allograft Transplantation ◽

Children's Hospitals ◽

Allograft Transplantation ◽

Meniscal Allograft ◽

Children’S Hospitals

Background: Meniscal allograft transplantation (MAT) is an option to slow the progression of degenerative disease in the setting of substantial meniscal deficiency. This may be especially important in children and adolescents, but there is little literature on MAT in this population. Hypothesis/Purpose: The purpose of this study was to evaluate the epidemiology of MAT in the pediatric population, with specific attention to regional and demographic trends. Methods: The Pediatric Health Information System, a national database consisting of 49 children’s hospitals, was queried for all patients undergoing MAT between 2011 and 2018. Demographic information was collected for each subject as well as data regarding previous and subsequent surgeries. The database was also queried for all meniscus surgeries (including repairs and meniscectomies) performed during the study period. Demographic and geographic data from this control group were compared to that of children undergoing MAT. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 27,168 meniscus surgeries were performed in 47 hospitals, with MAT performed 67 times in 17 hospitals. Twelve patients (18%) underwent a subsequent procedure after transplantation. In multivariate analysis, each year of increasing age resulted in 1.1 times higher odds of having undergone MAT rather than repair or meniscectomy (95% CI 1.03-1.1, p=0.002). Patients that underwent transplantation had 2.0 times higher odds of being female (95% CI 1.2-3.3, p=0.01) and 2.0 times higher odds of being commercially insured (95% CI 1.1-3.6, p=0.02). MAT was performed most frequently in the Northeast (4.9/1000 meniscus surgeries) and least often in the South (1.1/1000 meniscus surgeries, p<0.001). Furthermore, transplantation was more likely to be performed in larger cities. The median pediatric population of cities in which MAT was performed was 983,268 (range 157,253-3,138,870) compared to 662,290 (range 4,420-4,311,500) in cities where it was not (p=0.04). Conclusion: In the United States, patients that underwent MAT were older, more likely to be female, and have commercial insurance than those undergoing meniscus repair or meniscectomy. MAT was only done in 17/47 children’s hospitals that perform meniscus surgery and was most frequently performed in the Northeast and in larger cities. These trends highlight the need for further research, especially regarding differences along the lines of sex and insurance status.

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Preparation of Children for Hospitalization in Acute Care Hospitals in the United States

PEDIATRICS ◽

10.1542/peds.68.3.361 ◽

1981 ◽

Vol 68 (3) ◽

pp. 361-368

Author(s):

Pat Azarnoff ◽

Patricia D. Woody

Keyword(s):

United States ◽

Acute Care ◽

Group Discussion ◽

Acute Care Hospitals ◽

The United States ◽

Pediatric Care ◽

Children's Hospitals ◽

General Hospitals ◽

Psychological Preparation ◽

Children’S Hospitals

To study the prevalence and nature of psychological preparation for pediatric care, children's hospitals and acute care general hospitals were surveyed, and 24 hospitals were visited. Of 1,427 hospitals responding, 468 (33%) provided regular, planned preparation services. Prior to hospitalization, group tours and group discussion were the two most frequently used methods. During hospitalization, children learned informally as events occurred, usually through conversations.

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Emergence of SARS-CoV-2 variants of concern in the pediatric population of the United States

10.1101/2021.05.22.21257660 ◽

2021 ◽

Author(s):

Jennifer Dien Bard ◽

Moiz Bootwalla ◽

Amy Leber ◽

Paul Planet ◽

Ahmed Moustafa ◽

...

Keyword(s):

United States ◽

Young Children ◽

Pediatric Population ◽

The United States ◽

Surveillance Program ◽

Children's Hospitals ◽

Prevalence Data ◽

Children’S Hospitals ◽

Report Data

The evolution of SARS-CoV2 virus has led to the emergence of variants of concern (VOC). Children, particularly <12 years old not yet eligible for vaccines, continue to be important reservoirs of SARS-CoV-2 yet VOC prevalence data in this population is lacking. We report data from a genomic surveillance program that includes 9 U.S. children's hospitals. Analysis of SARS-CoV-2 genome from 2119 patients <19 years old between 03/20 to 04/21 identified 252 VOCs and 560 VOC signature mutations, most from 10/20 onwards. From 02/21 to 04/21, B.1.1.7 prevalence increased from 3.85% to 72.22% corresponding with the decline of B.1.429/B.1.427 from 51.82% to 16.67% at one institution. 71.74% of the VOC signature mutations detected were in children <12 years old, including 33 cases of B.1.1.7 and 119 of B.1.429/B.1.427. There continues to be a need for ongoing genomic surveillance, particularly among young children who will be the last groups to be vaccinated.

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