The Impact of Payer Source on Trauma Outcomes in a Pediatric Population

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures

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The impact of frailty on trauma outcomes using the Clinical Frailty Scale

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01627-x ◽

2021 ◽

Author(s):

Amari Thompson ◽

Sunil Gida ◽

Yasar Nassif ◽

Carla Hope ◽

Adam Brooks

Keyword(s):

Clinical Frailty Scale ◽

Trauma Outcomes ◽

The Impact

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The association of psychiatric and neurological comorbidities with outcomes in traumatic injury patients

The International Journal of Psychiatry in Medicine ◽

10.1177/0091217421989147 ◽

2021 ◽

pp. 009121742198914

Author(s):

Jennifer Brady ◽

R David Hayward ◽

Elango Edhayan

Keyword(s):

Length Of Stay ◽

Psychiatric Illness ◽

Traumatic Injury ◽

Lower Mortality ◽

Linear Modeling ◽

Psychiatric Comorbidities ◽

Trauma Outcomes ◽

Hospital Stays ◽

The Impact ◽

The Relationship

Introduction Mental illness is a well-known risk factor for injury and injury recidivism. The impact of pre-existing psychiatric illness on trauma outcomes, however, has received less attention. Our study examines the relationship of pre-existing psychiatric illness on trauma outcomes including length of stay, cost, and mortality. Methods Patient data were obtained from the Healthcare Cost and Utilization Project’s State Inpatient Database. All patients admitted for trauma in the Detroit metropolitan area from 1/1/2006 to 12/31/2014 were included. The relationship between individual psychiatric comorbidities (depression, psychosis, and other neurological disorders) and outcomes were evaluated with logistic regression (mortality) and generalized linear modeling (length of stay and cost). Results Over 260,000 records were reviewed. Approximately one-third (29.9%) of patients had one or more psychiatric diagnoses. Patients with depression had longer hospital stays (RR = 1.12, p < 0.001) and higher costs (RR = 1.07, p < 0.001), but also lower mortality (OR = 0.69, p < 0.001). Patients with psychosis had longer stays (RR = 1.18, p < 0.001), higher costs (RR = 1.02, p = 0.002), and lower mortality (OR = 0.61, p < 0.001). Patients with other neurological comorbidities had higher mortality (OR = 1.23, p < 0.001), longer stays (RR = 1.29, p < 0.001), and higher costs (RR = 1.10, p < 0.001). Conclusion Patients with a psychiatric disorder required longer care and incurred greater costs, whereas mortality was higher for only those with a neurological disorder. Identifying patients’ psychiatric comorbidities at the time of admission for trauma may help optimize treatment. Addressing these conditions may help reduce the cost of trauma care.

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A Case of COVID-19-Related Thrombocytopenia and Leukopenia in an Adolescent with Mild Symptoms

Children ◽

10.3390/children8060509 ◽

2021 ◽

Vol 8 (6) ◽

pp. 509

Author(s):

Lydia Kossiva ◽

Athanasios Thirios ◽

Eleni Panagouli ◽

Alexandros Panos ◽

Stavroula Lampidi ◽

...

Keyword(s):

Bone Marrow ◽

Viral Infection ◽

Nasal Congestion ◽

Pediatric Population ◽

Clinical Manifestations ◽

Bone Marrow Aspiration ◽

White Blood Count ◽

Chronic Obstructive ◽

First Case ◽

The Impact

Since the beginning of the COVID-19 pandemic, there have been numerous reports and reviews on the complications caused by the disease, analyzing the acute and chronic consequences. The main symptoms of SARS-CoV-2 are dry cough, fever, and fatigue. COVID-19 appears to affect all systems, including renal, cardiovascular, circulatory, and respiratory systems, causing chronic obstructive pulmonary disease. We report on a 14-year-old male adolescent, who presented with thrombocytopenia (platelet count 92 × 109 /L) and leukopenia (white blood count 4.2 × 103 /μL) that was observed two months ago. Ten days before the first blood test, a viral infection with nasal congestion and runny nose was reported, without other accompanying symptoms. Viral antibodies screening revealed positivity for all the three specific COVID-19 antibodies. Further haematological evaluation with bone marrow aspiration revealed non-specific dysplastic features of the red cell and megakaryocyte progenitors. Although haematological alterations due to COVID-19 infection are available from adult patients’ reports, the effect of COVID-19 infection in the pediatric population is underestimated and this is the first case with such haematological involvement. Noteworthy, in the current case, the impact of the COVID-19 infection was not related to the severity of the disease, as the symptoms were mild. In similar cases, bone marrow aspiration would not be performed as a part of routine work-up. Thus, it is important when evaluating pediatric patients with COVID-19 infection to search and report those alterations in order to better understand the impact and the spectrum of clinical manifestations of the specific viral infection in children and adolescents.

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The impact of obstructive sleep apnea on endothelial function during weight loss in an obese pediatric population

Sleep Medicine ◽

10.1016/j.sleep.2021.08.002 ◽

2021 ◽

Author(s):

Sofie Jacobs ◽

Emilie Mylemans ◽

Marijke Ysebaert ◽

Eline Vermeiren ◽

Ann De Guchtenaere ◽

...

Keyword(s):

Weight Loss ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Endothelial Function ◽

Pediatric Population ◽

Obstructive Sleep ◽

The Impact

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Stiffness of the Masseter Muscle in Children—Establishing the Reference Values in the Pediatric Population Using Shear-Wave Elastography

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189619 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9619

Author(s):

Cyprian Olchowy ◽

Anna Olchowy ◽

Aleksander Pawluś ◽

Mieszko Więckiewicz ◽

Luca Maria Sconfienza

Keyword(s):

Shear Wave ◽

Masseter Muscle ◽

Pediatric Population ◽

Shear Wave Elastography ◽

Total Sample ◽

Healthy Children ◽

Significant Difference ◽

The Right ◽

The Impact ◽

Masseter Muscles

In children, the quality and muscle function are altered in many pathologic conditions, including temporomandibular disorders. Although several methods have been used to evaluate muscle tonus, none became a golden standard. Moreover, the masseter muscle characteristics in children have not been investigated to date. This study aimed to measure the stiffness of the masseter muscle using shear-wave elastography in healthy children. We enrolled 30 healthy children (mean age 10.87 ± 3.38 years). The stiffness of masseter muscles was measured with shear wave elastography. Stiffness for the total sample was 6.37 ± 0.77 kPa. A comparison of the measurements did not show significant differences between the right and the left masseter muscles (left—6.47 ± 0.78 kPa; right—6.24 ± 0.76 kPa; p = 0.3546). A significant difference was seen between boys and girls (boys—5.94 ± 0.50 kPa; girls—6.63 ± 0.80; p = 0.0006). Shear-wave elastography is a promising diagnostic tool. It may help to detect changes in the stiffness of the masseter muscle and draw attention to pathological processes within the jaw muscles. Directions for further research shall include determining stiffness values in pathological conditions and the impact of biological and functional factors on the stiffness of the masseter muscle.

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Emerging Role of Microbiome in the Prevention of Urinary Tract Infections in Children

International Journal of Molecular Sciences ◽

10.3390/ijms23020870 ◽

2022 ◽

Vol 23 (2) ◽

pp. 870

Author(s):

Anna Kawalec ◽

Danuta Zwolińska

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urinary Tract Infections ◽

Pediatric Population ◽

Urologic Diseases ◽

Increased Risk ◽

Tract Infections ◽

The Impact

The microbiome of the urinary tract plays a significant role in maintaining health through the impact on bladder homeostasis. Urobiome is of great importance in maintaining the urothelial integrity and preventing urinary tract infection (UTI), as well as promoting local immune function. Dysbiosis in this area has been linked to an increased risk of UTIs, nephrolithiasis, and dysfunction of the lower urinary tract. However, the number of studies in the pediatric population is limited, thus the characteristic of the urobiome in children, its role in a child’s health, and pediatric urologic diseases are not completely understood. This review aims to characterize the healthy urobiome in children, the role of dysbiosis in urinary tract infection, and to summarize the strategies to modification and reshape disease-prone microbiomes in pediatric patients with recurrent urinary tract infections.

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Short‐term outcomes in children following emergency department visits for minor injuries sustained at home

Injury Epidemiology ◽

10.1186/s40621-021-00307-z ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Matthew J Molloy ◽

Wendy Shields ◽

Molly W Stevens ◽

Andrea C Gielen

Keyword(s):

Emergency Department ◽

Pediatric Population ◽

Pediatric Emergency ◽

Emergency Department Visits ◽

Short Term ◽

Minor Injury ◽

Minor Injuries ◽

A Minor ◽

The Impact ◽

At Home

Abstract Background Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. Methods Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. Results The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). Conclusions Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

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Progress in Pediatric Kidney Transplantation

The Open Urology & Nephrology Journal ◽

10.2174/1874303x014070100115 ◽

2014 ◽

Vol 7 (1) ◽

pp. 115-122

Author(s):

Jodi M. Smith ◽

Vikas R. Dharnidharka

Keyword(s):

Kidney Transplantation ◽

Graft Survival ◽

Pediatric Population ◽

Short Term ◽

Allocation Policy ◽

Pediatric Kidney Transplantation ◽

Timely Access ◽

The Impact ◽

Made In

Significant progress has been made in pediatric kidney transplantation. Advances in immunosuppression have dramatically decreased rates of acute rejection leading to improved short term graft survival but similar improvements in long term graft survival remain elusive. Changes in allocation policy provide the pediatric population with timely access to transplant but there remains concern about the impact of less HLA matching and a decrease in living donors. This report presents data from North America on these successes and the ongoing challenges that face the pediatric transplant community.

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