Rapid exome and genome sequencing in critically ill pediatric patients: 3-year experience from the Children’s Hospital of Michigan

2021 ◽  
Vol 132 ◽  
pp. S111-S112
Author(s):  
Melissa Hicks ◽  
Shagun Kaur ◽  
Robert Conway ◽  
Kara Pappas ◽  
Kuntal Sen
Keyword(s):  
Critically Ill ◽  
Genome Sequencing ◽  
Pediatric Patients ◽  
Children's Hospital ◽  
Children’S Hospital

scholarly journals A Retrospective Review of Hospital-Acquired Venous Thromboembolism at a Large Pediatric Tertiary Care Center

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3471-3471
Author(s):  
Marissa A. Just ◽  
Joanna Robles ◽  
Karan R. Kumar ◽  
Andrew Yazman ◽  
Jennifer A. Rothman ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Research Funding ◽  
Pediatric Patients ◽  
Central Venous ◽  
Vte Prophylaxis ◽  
Children's Hospital ◽  
Congenital Cardiac Disease ◽  
Children’S Hospital ◽  
Icd 10 ◽  
Hospital Acquired

Introduction: The incidence of venous thromboembolism (VTE) in hospitalized pediatric patients is increasing secondary to the growing medical complexity of pediatric patients and the increasing use of central venous catheters. Pediatric patients diagnosed with VTE have up to 2% mortality associated directly with their thromboses. While incidence, risk factor identification and preventive strategies are well established in hospitalized adults, this information is limited in the pediatric population. There are currently no standardized VTE risk screening tools or thromboprophylaxis guidelines for children at Duke Children's Hospital. The incidence of hospital acquired VTE (HA-VTE), as well as their associated risk factors were investigated in a retrospective review. Methods: Medical records of pediatric patients hospitalized at Duke Children's Hospital during June 2018 through November 2018 were reviewed. The EPIC SlicerDicer tool was used to identify patients with ICD-10 diagnoses codes related to thrombosis or treated with anticoagulants. Included patients were diagnosed with HA-VTE during their hospitalization or within 14 days of discharge. Data collected included demographics, thrombosis characteristics, family history, mobility, and acute or chronic co-morbid conditions. The characteristics of the study population were described by median (with 25th and 75th percentiles) for continuous variables and frequencies (with percentages) for binary or categorical variables. Results: Out of 4,176 total pediatric admissions to all units of Duke Children's Hospital (ages 0-18.99 years) during the inclusion timeframe, 33 VTE events were identified. The incidence of VTE events per 1000 patient days was 0.98. The complete patient and VTE event characteristics are listed in Tables 1 and 2. The median age of patients with VTE events was 0.4 years. Of the identified cohort, 73% had an associated central venous line (CVL). Neonates with congenital cardiac disease comprised the majority of the cohort. Other common patient characteristics observed in this cohort included impaired mobility, recent major surgery, and recent mechanical ventilation. Of the 33 VTE diagnoses, 70% received therapeutic anticoagulation with enoxaparin or unfractionated heparin. Only 2 patients (8%) received prophylactic anticoagulation prior to their diagnosis of VTE. Conclusions: The retrospective review of HA-VTE events at Duke Children's Hospital identified that the majority of the events occurred in neonates with congenital cardiac disease and the presence of CVLs. It was also noted that there was no standardization among the use of anticoagulation agents that were initiated for treatment of VTE. Furthermore, few patients received VTE prophylaxis during the hospitalization. A limitation of this review was that it was retrospective and the documentation of family history of thrombosis was inconsistent. It is also possible that several VTE events were missed due to inadequate ICD-10 coding. Based on the results of this review, there is a need to implement a risk stratification tool and develop standardized recommendations of VTE prophylaxis and treatments for pediatric patients admitted to Duke Children's Hospital. There is an additional quality improvement phase of this project and the goal is to implement a risk calculator that is based on information learned from the retrospective review. Ultimately, this risk calculator will help to decrease the incidence of VTE events at Duke Children's Hospital. Disclosures Rothman: Agios: Honoraria, Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Novartis: Honoraria, Research Funding.

scholarly journals Improving Pediatric Adverse Drug Event Reporting through Clinical Pharmacy Services

2011 ◽  
Vol 16 (4) ◽  
pp. 285-290
Author(s):  
David M. Crowther ◽  
Marcia L. Buck ◽  
Michelle W. McCarthy ◽  
Virginia W. Barton
Keyword(s):  
Causative Agent ◽  
Adverse Drug Event ◽  
Pediatric Patients ◽  
Drug Event ◽  
University Of Virginia ◽  
Children's Hospital ◽  
Therapeutic Class ◽  
Children’S Hospital ◽  
The University

OBJECTIVES The purpose of this study was to summarize adverse drug event (ADE) reporting and to characterize the type of healthcare practitioners involved in reporting over a 10-year period at a 120-bed university-affiliated children's hospital. METHODS The University of Virginia Children's Hospital ADE database was analyzed for records involving pediatric patients. Data from patients <18 years of age who were admitted to the University of Virginia Children's Hospital between January 1, 2000, and December 31, 2009, were analyzed. Data collected included drug name and therapeutic class of the suspected causative agent, description of the event, severity, causality, outcome, and the type of healthcare practitioner reporting the event. RESULTS A total of 863 ADEs were reported over the 10-year period. The 5 most common types reported were extravasation injury (10%), rash (8%), hypotension (5%), pruritus (5%), and renal failure (3%). A total of 196 (21%) cases were categorized as mild, 436 (47%) cases as moderate, and 296 (32%) cases as severe. Further characterization of extravasations was performed to identify trends relating to potential causes. In 45 (57%) reports, parenteral nutrition was identified as the causative agent. Full recovery was documented in 21 (47%) extravasations. Of the total events reported, 83% were reported by pharmacists, 16% by nurses, and <1% by other healthcare practitioners. CONCLUSIONS Results of this study are consistent with those of previous studies involving ADE reporting in children's hospitals. This consistency is due in part to system design and use of unit-based pharmacists as the primary reporters.

scholarly journals MENISCUS REPAIR VERSUS DEBRIDEMENT FOR MENISCAL TEARS IN PEDIATRIC PATIENTS – PREDICTORS FOR TREATMENT BASED ON DEMOGRAPHICS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0016
Author(s):  
Lauren Agatstein ◽  
Alton W. Skaggs ◽  
Matthew J. Brown ◽  
Nicole Friel ◽  
Brian Haus
Keyword(s):  
Pediatric Patients ◽  
Private Insurance ◽  
Meniscal Repair ◽  
Meniscus Repair ◽  
Meniscus Tear ◽  
Children's Hospitals ◽  
Children's Hospital ◽  
Children’S Hospitals ◽  
Meniscus Tears ◽  
Children’S Hospital

BACKGROUND: Pediatric and adolescent patients with meniscus tears have a relatively high rate of healing after meniscus repair – up to greater than 80% in the literature. Despite this fact, many patients undergo meniscus debridement for treatment of their meniscus tears. In this study, we investigated the demographic factors predictive of whether a pediatric patient would receive a meniscal repair or a meniscal debridement for their meniscal tear. METHODS: The California statewide ambulatory surgery database (OSHPD) was queried for all patients under 18 years old who underwent meniscus debridement or meniscus repair from 2008-2016. The effect of age, hospital setting (adult versus pediatric hospital), injury chronicity, gender, insurance type, race, and year of service was assessed using logistic regression. RESULTS: A total of 13,906 pediatric patients had meniscal surgery during the timeframe. 83% (11,561/13,906) underwent meniscal debridement and 17% (2,345/13,906) underwent meniscal repair. Age, hospital type, nature of injury, gender, private insurance, being Hispanic, and year of service were statistically significant in predicting the odds of having meniscus repair versus meniscus debridement. Surgery at a children’s hospital increases the odds of having meniscus repair (p < 0.001). Of the 82.6% of pediatric patients (11,491/13,906) treated at non-children’s hospitals, 16% (1839) had repair and 84% underwent debridement (9,652). Of the 17.4% (2,415) treated at children’s hospitals, 21% (506) had repair and 79% (1,909) underwent debridement. As patients age, the odds of receiving a meniscus repair decrease (p < 0.001). Acute meniscus injury (p < 0.001) or private insurance (p < 0.05) increase the odds of having meniscus repair. However, females (p < 0.05) and Hispanics (p < 0.01) had decreased odds of having meniscus repair. As time between injury and surgery progressed, the odds of having meniscus repair versus meniscus debridement increased (p < 0.001). CONCLUSIONS: There is increasing evidence that pediatric patients have successful outcomes after meniscal repair surgery. The results of this study demonstrate that the majority of pediatric patients with meniscus tears undergo a meniscal debridement rather than a repair. Treatment at a children’s hospital, private insurance, and a short time frame between injury and surgery were positive predictors of meniscus repair over debridement. The results of the study may help inform patients, families, and referring physicians about what type of treatment a patient may receive for a meniscus tear, based on their demographic profile.

scholarly journals Correction to: Bican, R., Christensen, C., Fallieras, K., Sagester, G., O’Rourke, S., Byars, M., & Tanner, K. (2021). Rapid Implementation of Telerehabilitation for Pediatric Patients During COVID-19

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Ellen R. Cohn
Keyword(s):  
Pediatric Patients ◽  
Physical Medicine ◽  
Children's Hospital ◽  
Children’S Hospital

Correction to: Bican, R., Christensen, C., Fallieras, K., Sagester, G., O’Rourke, S., Byars, M., & Tanner, K. (2021). Rapid Implementation of Telerehabilitation for Pediatric Patients During COVID-19. International Journal of Telerehabilitation, 13(1). https://doi.org/10.5195/ijt.2021.6371 The affiliation for each author was incorrectly stated as: Physical Medicine & Rehabilitation, Children’s Minnesota, Minneapolis, Minnesota, USA The correct affiliation for each author is: Clinical Therapies, Nationwide Children’s Hospital, Columbus, Ohio, USA The metadata for the original article has been corrected.

scholarly journals Can Clinical Symptoms and Laboratory Results Predict CT Abnormality? Initial Findings Using Novel Machine Learning Techniques in Children With COVID-19 Infections

2021 ◽  
Vol 8 ◽  
Author(s):  
Huijing Ma ◽  
Qinghao Ye ◽  
Weiping Ding ◽  
Yinghui Jiang ◽  
Minhao Wang ◽  
...  
Keyword(s):  
Machine Learning ◽  
Clinical Data ◽  
Pediatric Patients ◽  
Clinical Symptoms ◽  
Chest Ct ◽  
Rt Pcr ◽  
Health Crisis ◽  
Children's Hospital ◽  
Laboratory Results ◽  
Children’S Hospital

The rapid spread of coronavirus 2019 disease (COVID-19) has manifested a global public health crisis, and chest CT has been proven to be a powerful tool for screening, triage, evaluation and prognosis in COVID-19 patients. However, CT is not only costly but also associated with an increased incidence of cancer, in particular for children. This study will question whether clinical symptoms and laboratory results can predict the CT outcomes for the pediatric patients with positive RT-PCR testing results in order to determine the necessity of CT for such a vulnerable group. Clinical data were collected from 244 consecutive pediatric patients (16 years of age and under) treated at Wuhan Children's Hospital with positive RT-PCR testing, and the chest CT were performed within 3 days of clinical data collection, from January 21 to March 8, 2020. This study was approved by the local ethics committee of Wuhan Children's Hospital. Advanced decision tree based machine learning models were developed for the prediction of CT outcomes. Results have shown that age, lymphocyte, neutrophils, ferritin and C-reactive protein are the most related clinical indicators for predicting CT outcomes for pediatric patients with positive RT-PCR testing. Our decision support system has managed to achieve an AUC of 0.84 with 0.82 accuracy and 0.84 sensitivity for predicting CT outcomes. Our model can effectively predict CT outcomes, and our findings have indicated that the use of CT should be reconsidered for pediatric patients, as it may not be indispensable.

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