81. Children and COVID-19 in Colorado: The Children’s Hospital Colorado Experience

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease of 2019 (COVID-19) and has been reported in > 98,000 children in the U.S (5% of reported cases) as of early June 2020. Most published literature focuses on adults with COVID-19, but little is understood on the impact of SARS-CoV-2 in children. We created a database for children with COVID-19 at Children’s Hospital Colorado (CHCO), a large tertiary care pediatric hospital, to better understand the epidemiology and clinical outcomes of this disease in children. Methods We retrospectively reviewed the medical records of all pediatric and youth patients with positive SARS-CoV-2 PCR test results from March-May 2020. Univariate logistic regression models were used to identify predictors of hospital admission, need for critical care, and need for respiratory support among symptomatic patients, with p-values < 0.05 considered statistically significant. Results We identified 246 patients with SARS-CoV-2 (age range: 17 days-25 years). We noted a Hispanic predominance with 68% of all patients with SARS-CoV-2 identifying as Hispanic or Latino, compared to 29% among all CHCO visits in 2019 (Figure 1). The most common symptoms at presentation were fever, cough, or shortness of breath in 94% of symptomatic patients. Sixty-eight patients (28%) were admitted, of which 7 (10%) required admission to the pediatric intensive care unit (PICU) for symptomatic COVID-19 disease (Figure 2). Age 0–3 months, certain symptoms at presentation, and several types of underlying medical conditions were predictors for both hospital admission and need for respiratory support (Figure 3). Initial and peak C-reactive protein (CRP) values were predictors for PICU admission with median peaks of 24.8mg/dL vs. 2.0mg/dL among PICU vs. non-PICU patients (OR 1.27, p=0.004). Figure 3: Predictors for Admission and Respiratory Support Requirement in CHCO Patients with SARS-CoV-2 Conclusion There is a wide spectrum of illness in children with SARS-CoV-2, ranging from asymptomatic to critical illness. Hispanic ethnicity was disproportionately represented in our cohort, which requires further evaluation. We found that young age, comorbid conditions, and CRP appear to be risk factors for severe disease in children. Disclosures Kelly E. Graff, MD, BioFire Diagnostics, LLC (Grant/Research Support)

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The Pediatric Emergency Transport System: Momentum toward Regionalization

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00044265 ◽

1985 ◽

Vol 1 (S1) ◽

pp. 156-157

Author(s):

Robert S. Dobrin ◽

Janet Cunningham ◽

Mary Dexter ◽

Chelle Gifford ◽

Liz Ivancie ◽

...

Keyword(s):

Intensive Care ◽

Tertiary Care ◽

Pediatric Intensive Care ◽

Rocky Mountain ◽

Pediatric Emergency ◽

Critically Ill Children ◽

Respiratory Therapists ◽

Children's Hospital ◽

Emergency Transport ◽

Children’S Hospital

Tertiary care for critically ill children requires a safe, efficient transport modality designed for the pediatric patient. This system should be capable of delivering mobile intensive care en route after resuscitation and stabilization at the sending hospital.In July 1979, a Pediatric Emergency Transport Service (PETS) was organized at The Children's Hospital, Denver, to provide physicians of the Rocky Mountain-Plains Region with the capability of triaging pediatric nonneonatal patients to three Denver Pediatric Intensive Care Units (PICU's). The components of the system included: (1) a transport team comprising of a medical attending-director, twelve transport physicians including nine pediatricians, two anesthesiologists and one surgeon, six pediatric transport nurses, six pediatric transport respiratory therapists, and four emergency medical technicians; (2) a communication dispatch system; (3) an answering service with Wide Area Telecommunications Service capability; (4) an equipment depot within the PICU at The Children's Hospital; (5) a complete dispatch log; (6) a continuing education and information system for the team, providers, consumers and health planners; (7) a cost and administrative center with established billing procedures and support services; (8| management, drug and equipment protocols, and (9) specifically designed air and ground ambulances which are owned and/or leased by The Children's Hospital.

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Improving Stethoscope Disinfection at a Children's Hospital

Infection Control and Hospital Epidemiology ◽

10.1086/673454 ◽

2013 ◽

Vol 34 (11) ◽

pp. 1189-1193 ◽

Cited By ~ 8

Author(s):

Justin Zaghi ◽

Jing Zhou ◽

Dionne A. Graham ◽

Gail Potter-Bynoe ◽

Thomas J. Sandora

Keyword(s):

Pathogenic Bacteria ◽

Healthcare Providers ◽

Future Research ◽

Healthcare Facilities ◽

Logistic Regression Models ◽

Children's Hospital ◽

Contact Precautions ◽

Before And After ◽

Children’S Hospital ◽

The Impact

Objective.Stethoscopes are contaminated with pathogenic bacteria and pose a risk for transmission of infections, but few clinicians disinfect their stethoscope after every use. We sought to improve stethoscope disinfection rates among pediatric healthcare providers by providing access to disinfection materials and visual reminders to disinfect stethoscopes.Design.Prospective intervention study.Setting. Inpatient units and emergency department of a major pediatric hospital.Participants.Physicians and nurses with high anticipated stethoscope use.Methods.Baskets filled with alcohol prep pads and a sticker reminding providers to regularly disinfect stethoscopes were installed outside of patient rooms. Healthcare providers' stethoscope disinfection behaviors were directly observed before and after the intervention. Multivariable logistic regression models were created to identify independent predictors of stethoscope disinfection.Results.Two hundred twenty-six observations were made in the preintervention period and 261 in the postintervention period (83% were of physicians). Stethoscope disinfection compliance increased significantly from a baseline of 34% to 59% postintervention (P < .001). In adjusted analyses, the postintervention period was associated with improved disinfection among both physicians (odds ratio [OR], 2.3 [95% confidence interval (CI), 1.4-3.5]) and nurses (OR, 14.3 [95% CI, 4.6-44.6]). Additional factors independently associated with disinfection included subspecialty unit (vs general pediatrics; OR, 0.5 [95% CI, 0.3-0.8]) and contact precautions (OR, 2.3 [95% CI, 1.2-4.1]).Conclusions.Providing stethoscope disinfection supplies and visible reminders outside of patient rooms significantly increased stethoscope disinfection rates among physicians and nurses at a children's hospital. This simple intervention could be replicated at other healthcare facilities. Future research should assess the impact on patient infections.

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The Association Between Age at Palatoplasty and Speech and Language Outcomes in Children With Cleft Palate: An Observational Chart Review Study

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619882566 ◽

2019 ◽

Vol 57 (2) ◽

pp. 148-160 ◽

Cited By ~ 2

Author(s):

Amber D. Shaffer ◽

Matthew D. Ford ◽

Joseph E. Losee ◽

Jesse Goldstein ◽

Bernard J. Costello ◽

...

Keyword(s):

Language Development ◽

Cleft Palate ◽

Outcome Measures ◽

Tertiary Care ◽

Language Delays ◽

Language Outcomes ◽

Speech And Language ◽

Children's Hospital ◽

Children’S Hospital ◽

The Impact

Objective: To determine whether timing of palatoplasty (early, standard, or late) is associated with speech and language outcomes in children with cleft palate. Design: Retrospective case series. Setting: Tertiary care children’s hospital. Participants: Records from 733 children born between 2005 and 2015 and treated at the Cleft Craniofacial Clinic of a tertiary children’s hospital were retrospectively reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, syndromes, staged palatoplasty, and introduction to clinic after 12 months of age. Data from 232 children with cleft palate ± cleft lip were analyzed. Interventions: Palatoplasty. Main Outcome Measures: Speech/language delays and disorders at 20 months and 5 years of age based on formal hospital or community-based testing or screening evaluation in the Cleft Craniofacial Clinic; additional speech surgery. Results: Median age at palatoplasty was 12.6 months (range: 8.8-21.9 months). Age at palatoplasty was classified as early (<11 months, n = 28), standard (11-13 months, n = 158), or late (>13 months, n = 46). Late palatoplasty was associated with increased odds of speech/language delays and speech therapy at 20 months, and language delays at 5 years, compared with standard or early palatoplasty ( P < .05 for all comparisons). However, speech sound production disorders, velopharyngeal incompetence, tube replacement, and hearing loss were not significantly associated with age at palatoplasty. Conclusions: Late palatoplasty may be associated with short- and long-term delays in speech/language development. Future studies with standardized surgical technique/timing and outcome measures are required to more definitively describe the impact of age at palatoplasty on speech/language development.

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Characteristics and risk factors of candidemia in pediatric intensive care unit of a tertiary care children's hospital in Egypt

The Journal of Infection in Developing Countries ◽

10.3855/jidc.4186 ◽

2014 ◽

Vol 8 (05) ◽

pp. 624-634 ◽

Cited By ~ 17

Author(s):

Moustafa Hegazi ◽

Alaa Abdelkader ◽

Maysaa Zaki ◽

Basem El-Deek

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Amphotericin B ◽

Pediatric Intensive Care Unit ◽

Tertiary Care ◽

Pediatric Intensive Care ◽

Attributable Mortality ◽

Candida Colonization ◽

Children's Hospital ◽

Children’S Hospital

Introduction: This study was conducted to determine characteristics of Candida colonization and candidemia in the pediatric intensive care unit (PICU) of a tertiary care children's hospital. Methodology: Patients between 6 months and 15 years of age consecutively admitted to the PICU of Mansoura University Children’s Hospital in Mansoura, Egypt, during one year period, were evaluated for Candida colonization and candidemia. Susceptibility of Candida species isolated from blood to fluconazole and amphotericin B was determined by Etest. Results: Sixty-six patients without prior fluconazole prophylaxis had 88 episodes of candidemia, representing 19% of all cases with blood stream infections (BSIs). Candida albicans (CA) and non-albicans Candida (NAC) species accounted for 40% and 60% of candidemia episodes respectively. C. parapsilosis, C. tropicalis, and C. glabrata accounted for 25%, 17%, and 8% of NAC candidemias respectively. Fluconazole resistance was detected in 11.4% and 18.9% of CA and NAC isolates respectively. Of the fluconazole resistant NAC isolates, four were C. krusei. Amphotericin B resistance was detected in 17% of NAC isolates. Candida colonization was detected in 78.8% of patients. Compared to CA candidemia, higher risk for NAC candidemia was associated with age older than 1 year, Candida isolation from endotracheal tube (ETT) and from central venous catheter. Mortality rate was 42.4%, attributable mortality of candidemia was 16.7%. Regression analysis showed that the most significant independent predictors of death were ETT and mechanical ventilation (MV), MV longer than 7 days, and candiduria. Conclusions: This study presents important epidemiological features of Candida BSIs in a non-neonatal population.

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Disruptions in Care: Consequences of the COVID-19 Pandemic in a Children’s Hospital

10.1101/2021.12.02.21266778 ◽

2021 ◽

Author(s):

Catherine Diskin ◽

Julia Orkin ◽

Blossom Dharmaraj ◽

Tanvi Agarwal ◽

Arpita Parmar ◽

...

Keyword(s):

Public Health ◽

Tertiary Care ◽

Healthcare Delivery ◽

Unintended Consequences ◽

Pediatric Care ◽

Care Hospital ◽

Children's Hospital ◽

Centered Care ◽

Children’S Hospital ◽

The Impact

AbstractBackgroundPublic health restrictions are an essential strategy to prevent the spread of COVID-19; however, unintended consequences of these interventions may have led to significant delays, deferrals and disruptions in medical care. This study explores clinical cases where the care of children was perceived to have been negatively impacted as a result of public health measures and changes in healthcare delivery and access due to the COVID-19 pandemic.MethodsThis study used a qualitative multiple case study design with descriptive thematic analysis of clinician-reported consequences of the COVID-19 pandemic on care provided at a children’s hospital. A quantitative analysis of overall hospital activity data during the study period was performed.ResultsThe COVID-19 pandemic has resulted in significant change to hospital activity at our tertiary care hospital, including an initial reduction in Emergency Department attendance by 38% and an increase in ambulatory virtual care from 4% before COVID-19, to 67% in August, 2020. Two hundred and twelve clinicians reported a total of 116 unique cases. Themes including (1) timeliness of care, (2) disruption of patient-centered care, (3) new pressures in the provision of safe and efficient care and (4) inequity in the experience of the COVID-19 pandemic emerged, each impacting patients, their families and healthcare providers.ConclusionBeing aware of the breadth of the impact of the COVID-19 pandemic across all of the identified themes is important to enable the delivery of timely, safe, high-quality, family-centred pediatric care moving forward.What’s newCOVID-19 disrupted typical paediatric care delivery.This study demonstrates the breadth of its’ impact on the delivery of timely, safe, equitable and patient and family centered care, highlighting considerations for paediatric providers as we move forward.

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Increased Continuity of Care Associated with Decreased Hospital Admission and Emergency Department Visits for Pediatric Patients with Asthma in Children’s Hospital, KSMC Riyadh

The International Annals of Medicine ◽

10.24087/iam.2017.1.10.337 ◽

2017 ◽

Vol 1 (10) ◽

Author(s):

Emadia Alaki ◽

Aziza Donques ◽

Abdullah Alkhamri

Keyword(s):

Emergency Department ◽

Hospital Admission ◽

Continuity Of Care ◽

Pediatric Patients ◽

Emergency Department Visits ◽

Children's Hospital ◽

Children’S Hospital

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Pediatric Surgical Reentry Strategy Following the COVID-19 Pandemic: A Tiered and Balanced Approach

The American Surgeon ◽

10.1177/00031348211011125 ◽

2021 ◽

pp. 000313482110111

Author(s):

Ryan C. Pickens ◽

Angela M. Kao ◽

Mark A. Williams ◽

Andrew C. Herman ◽

Jeffrey S. Kneisl

Keyword(s):

Pediatric Surgery ◽

Elective Surgery ◽

Surgical Care ◽

Children's Hospital ◽

Protocol Development ◽

Balanced Approach ◽

Projective Curves ◽

Children’S Hospital ◽

The Impact ◽

Emergent Surgery

Background In response to the COVID-19 pandemic, children’s hospitals across the country postponed elective surgery beginning in March 2020. As projective curves flattened, administrators and surgeons sought to develop strategies to safely resume non-emergent surgery. This article reviews challenges and solutions specific to a children’s hospital related to the resumption of elective pediatric surgeries. We present our tiered reentry approach for pediatric surgery as well as report early data for surgical volume and tracking COVID-19 cases during reentry. Methods The experience of shutdown, protocol development, and early reentry of elective pediatric surgery are reported from Levine’s Children’s Hospital (LCH), a free-leaning children’s hospital in Charlotte, North Carolina. Data reported were obtained from de-identified hospital databases. Results Pediatric surgery experienced a dramatic decrease in case volumes at LCH during the shutdown, variable by specialty. A tiered and balanced reentry strategy was implemented with steady resumption of elective surgery following strict pre-procedural screening and testing. Early outcomes showed a steady thorough fluctuating increase in elective case volumes without evidence of a surgery-associated positive spread through periprocedural tracking. Conclusion Reentry of non-emergent pediatric surgical care requires unique considerations including the impact of COVID-19 on children, each children hospital structure and resources, and preventing undue delay in intervention for age- and disease-specific pediatric conditions. A carefully balanced strategy has been critical for safe reentry following the anticipated surge. Ongoing tracking of resource utilization, operative volumes, and testing results will remain vital as community spread continues to fluctuate across the country.

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Handshake antimicrobial stewardship as a model to recognize and prevent diagnostic errors

Diagnosis ◽

10.1515/dx-2020-0032 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Justin B. Searns ◽

Manon C. Williams ◽

Christine E. MacBrayne ◽

Ann L. Wirtz ◽

Jan E. Leonard ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Interrater Reliability ◽

Diagnostic Errors ◽

Diagnostic Error ◽

Primary Treatment ◽

Treatment Team ◽

Children's Hospital ◽

Children’S Hospital ◽

The Impact ◽

Made In

AbstractObjectivesFew studies describe the impact of antimicrobial stewardship programs (ASPs) on recognizing and preventing diagnostic errors. Handshake stewardship (HS-ASP) is a novel ASP model that prospectively reviews hospital-wide antimicrobial usage with recommendations made in person to treatment teams. The purpose of this study was to determine if HS-ASP could identify and intervene on potential diagnostic errors for children hospitalized at a quaternary care children’s hospital.MethodsPreviously self-identified “Great Catch” (GC) interventions by the Children’s Hospital Colorado HS-ASP team from 10/2014 through 5/2018 were retrospectively reviewed. Each GC was categorized based on the types of recommendations from HS-ASP, including if any diagnostic recommendations were made to the treatment team. Each GC was independently scored using the “Safer Dx Instrument” to determine presence of diagnostic error based on a previously determined cut-off score of ≤1.50. Interrater reliability for the instrument was measured using a randomized subset of one third of GCs.ResultsDuring the study period, there were 162 GC interventions. Of these, 65 (40%) included diagnostic recommendations by HS-ASP and 19 (12%) had a Safer Dx Score of ≤1.50, (Κ=0.44; moderate agreement). Of those GCs associated with diagnostic errors, the HS-ASP team made a diagnostic recommendation to the primary treatment team 95% of the time.ConclusionsHandshake stewardship has the potential to identify and intervene on diagnostic errors for hospitalized children.

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