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A Closer Look: Examination of Suicide Risk Screening Results and Outcomes for Minoritized Youth in Subspecialty Pediatrics

Lois, Becky H; Mournet, Annabelle M; Menz, Reagan; King, Mya; Malizia, Rebecca; Haines, Elizabeth; Coble-Sadaphal, Chanelle; Liaw, K Ron-Li
OBJECTIVE:To describe a sample of minoritized youth who screened positive for suicide risk within medical subspecialty pediatrics, compared to non-minoritized youth and describe the screening outcomes of these youth. METHODS:This retrospective chart review from October 2018 to April 2021 used electronic medical record data from an academic pediatric medical subspecialty clinic that screens universally for suicide risk for all patients ages 9 and up. Chart reviews were conducted for 237 minoritized youth (operationalized as identifying as non-White or Hispanic/Latinx, identifying as a gender minority, and having a preferred language other than English) who screened positive for suicide risk. Descriptive statistics include need for escalation to an emergency room, connection to mental health care, receival of a mental health referral, and attendance at follow-up visits. RESULTS:Minoritized youth were more likely to screen positive and report a history of suicide attempt when compared to non-minoritized peers. Youth identifying as gender expansive had significant elevation in suicide risk. The majority of youth in this sample were already connected to mental health care, with youth preferring a language other than English being the least likely to be connected. CONCLUSIONS:Findings indicate heightened suicide risk for minoritized youth, with gender expansive youth having particularly elevated suicide risk. A need to support youth with a preferred language other than English in getting connected to mental health care was also revealed.
PMID: 35597439
ISSN: 1876-2867
CID: 5247752

Omphalitis and Concurrent Serious Bacterial Infection

Kaplan, Ron L; Cruz, Andrea T; Freedman, Stephen B; Smith, Kathleen; Freeman, Julia; Lane, Roni D; Michelson, Kenneth A; Marble, Richard D; Middelberg, Leah K; Bergmann, Kelly R; McAneney, Constance; Noorbakhsh, Kathleen A; Pruitt, Christopher; Shah, Nipam; Badaki-Makun, Oluwakemi; Schnadower, David; Thompson, Amy D; Blackstone, Mercedes M; Abramo, Thomas J; Srivastava, Geetanjali; Avva, Usha; Samuels-Kalow, Margaret; Morientes, Oihane; Kannikeswaran, Nirupama; Chaudhari, Pradip P; Strutt, Jonathan; Vance, Cheryl; Haines, Elizabeth; Khanna, Kajal; Gerard, James; Bajaj, Lalit
OBJECTIVE:Describe the clinical presentation, prevalence of concurrent serious bacterial infection (SBI), and outcomes among infants with omphalitis. METHODS:Within the Pediatric Emergency Medicine Collaborative Research Committee, 28 sites reviewed records of infants ≤90 days of age with omphalitis seen in the emergency department from January 1, 2008, to December 31, 2017. Demographic, clinical, laboratory, treatment, and outcome data were summarized. RESULTS:Among 566 infants (median age 16 days), 537 (95%) were well-appearing, 64 (11%) had fever at home or in the emergency department, and 143 (25%) had reported fussiness or poor feeding. Blood, urine, and cerebrospinal fluid cultures were collected in 472 (83%), 326 (58%), and 222 (39%) infants, respectively. Pathogens grew in 1.1% (95% confidence interval [CI], 0.3%-2.5%) of blood, 0.9% (95% CI, 0.2%-2.7%) of urine, and 0.9% (95% CI, 0.1%-3.2%) of cerebrospinal fluid cultures. Cultures from the site of infection were obtained in 320 (57%) infants, with 85% (95% CI, 80%-88%) growing a pathogen, most commonly methicillin-sensitive Staphylococcus aureus (62%), followed by methicillin-resistant Staphylococcus aureus (11%) and Escherichia coli (10%). Four hundred ninety-eight (88%) were hospitalized, 81 (16%) to an ICU. Twelve (2.1% [95% CI, 1.1%-3.7%]) had sepsis or shock, and 2 (0.4% [95% CI, 0.0%-1.3%]) had severe cellulitis or necrotizing soft tissue infection. There was 1 death. Serious complications occurred only in infants aged <28 days. CONCLUSIONS:In this multicenter cohort, mild, localized disease was typical of omphalitis. SBI and adverse outcomes were uncommon. Depending on age, routine testing for SBI is likely unnecessary in most afebrile, well-appearing infants with omphalitis.
PMID: 35441224
ISSN: 1098-4275
CID: 5215482

Interobserver Agreement of Inferior Vena Cava Ultrasound Collapse Duration and Correlated Outcomes in Children With Dehydration

Zhou, Amy Z; Green, Robert S; Haines, Elizabeth J; Vazquez, Michelle N; Tay, Ee T; Tsung, James W
OBJECTIVE:Dehydration is a common concern in children presenting to pediatric emergency departments and other acute care settings. Ultrasound (US) of the inferior vena cava (IVC) may be a fast, noninvasive tool to gauge volume status, but its utility is unclear. Our objectives were to determine the interobserver agreement of IVC collapse and collapse duration, then correlate IVC collapse with the outcome of intravenous (IV) versus oral (PO) rehydration. METHODS:We conducted a prospective study by enrolling patients 0 to 21 years old with emesis requiring ondansetron or diarrhea requiring IV hydration. Clinical operators interpreted US examinations in real time to determine whether the IVC was collapsed. Two blinded reviewers interpreted the US videos to determine IVC collapse and collapse duration. Cohen's kappa(κ) was calculated for reviewer-reviewer and reviewer-operator agreement. Primary outcomes were PO versus IV rehydration, and admitted versus discharged. RESULTS:One hundred twelve patients were enrolled, and 102 had complete data for analysis. The mean age was 7.2 years with 51% female. Twenty-nine patients received IV hydration. The reviewer-operator agreement for IVC collapse was κ = 0.57 (95% confidence interval [CI], 0.38-0.75) and interreviewer agreement was κ = 0.93 (95% CI, 0.83-1.0). The interreviewer agreement for collapse duration was κ = 0.66 (95% CI, 0.51-0.82). All patients with noncollapsed IVCs tolerated PO hydration. The likelihood of receiving IV hydration was correlated with the duration of IVC collapse (P = 0.034). CONCLUSIONS:Based on a novel dynamic measure of IVC collapse duration, children with increasing duration of IVC collapse correlated positively with the need for IV rehydration. Noncollapsing IVCs on US were associated with successful PO rehydration without need for IV fluids or emergency department revisits.
PMID: 32530838
ISSN: 1535-1815
CID: 4478682

Neonatal Mastitis and Concurrent Serious Bacterial Infection

Kaplan, Ron L; Cruz, Andrea T; Michelson, Kenneth A; McAneney, Constance; Blackstone, Mercedes M; Pruitt, Christopher M; Shah, Nipam; Noorbakhsh, Kathleen A; Abramo, Thomas J; Marble, Richard D; Middelberg, Leah; Smith, Kathleen; Kannikeswaran, Nirupama; Schnadower, David; Srivastava, Geetanjali; Thompson, Amy D; Lane, Roni D; Freeman, Julia F; Bergmann, Kelly R; Morientes, Oihane; Gerard, James; Badaki-Makun, Oluwakemi; Avva, Usha; Chaudhari, Pradip P; Freedman, Stephen B; Samuels-Kalow, Margaret; Haines, Elizabeth; Strutt, Jonathan; Khanna, Kajal; Vance, Cheryl; Bajaj, Lalit
OBJECTIVES:Describe the clinical presentation, prevalence, and outcomes of concurrent serious bacterial infection (SBI) among infants with mastitis. METHODS:Within the Pediatric Emergency Medicine Collaborative Research Committee, 28 sites reviewed records of infants aged ≤90 days with mastitis who were seen in the emergency department between January 1, 2008, and December 31, 2017. Demographic, clinical, laboratory, treatment, and outcome data were summarized. RESULTS:(8%). A total of 591 (90%) infants were admitted to the hospital, with 22 (3.7%) admitted to an ICU. Overall, 10 (1.5% [95% CI 0.7-2.8]) had sepsis or shock, and 2 (0.3% [95% CI 0.04-1.1]) had severe cellulitis or necrotizing soft tissue infection. None received vasopressors or endotracheal intubation. There were no deaths. CONCLUSIONS:In this multicenter cohort, mild localized disease was typical of neonatal mastitis. SBI and adverse outcomes were rare. Evaluation for SBI is likely unnecessary in most afebrile, well-appearing infants with mastitis.
PMID: 34187909
ISSN: 1098-4275
CID: 5062992

Virtual Urgent Care Quality and Safety in the Time of Coronavirus

Smith, Silas W; Tiu, Janelle; Caspers, Christopher G; Lakdawala, Viraj S; Koziatek, Christian A; Swartz, Jordan L; Lee, David C; Jamin, Catherine T; Femia, Robert J; Haines, Elizabeth J
BACKGROUND:Telemedicine use rapidly increased during the COVID-19 pandemic. This study assessed quality aspects of rapid expansion of a virtual urgent care (VUC) telehealth system and the effects of a secondary telephonic screening initiative during the pandemic. METHODS:A retrospective cohort analysis was performed in a single health care network of VUC patients from March 1, 2020, through April 20, 2020. Researchers abstracted demographic data, comorbidities, VUC return visits, emergency department (ED) referrals and ED visits, dispositions, intubations, and deaths. The team also reviewed incomplete visits. For comparison, the study evaluated outcomes of non-admission dispositions from the ED: return visits with and without admission and deaths. We separately analyzed the effects of enhanced callback system targeting higher-risk patients with COVID-like illness during the last two weeks of the study period. RESULTS:A total of 18,278 unique adult patients completed 22,413 VUC visits. Separately, 718 patient-scheduled visits were incomplete; the majority were no-shows. The study found that 50.9% of all patients and 74.1% of patients aged 60 years or older had comorbidities. Of VUC visits, 6.8% had a subsequent VUC encounter within 72 hours; 1.8% had a subsequent ED visit. Of patients with enhanced follow-up, 4.3% were referred for ED evaluation. Mortality was 0.20% overall; 0.21% initially and 0.16% with enhanced follow-up (p = 0.59). Males and black patients were significantly overrepresented in decedents. CONCLUSION/CONCLUSIONS:Appropriately deployed VUC services can provide a pragmatic strategy to care for large numbers of patients. Ongoing surveillance of operational, technical, and clinical factors is critical for patient quality and safety with this modality.
PMCID:7566682
PMID: 33358323
ISSN: 1938-131x
CID: 4731212

Prediction of Resuscitation for Pediatric Sepsis from Data Available at Triage

Stella, Peter; Haines, Elizabeth; Aphinyanaphongs, Yindalon
Pediatric sepsis imposes a significant burden of morbidity and mortality among children. While the speedy application of existing supportive care measures can substantially improve outcomes, further improvements in delivering that care require tools that go beyond recognizing sepsis and towards predicting its development. Machine learning techniques have great potential as predictive tools, but their application to pediatric sepsis has been stymied by several factors, particularly the relative rarity of its occurrence. We propose an alternate approach which focuses on predicting the provision of resuscitative care, rather than sepsis diagnoses or criteria themselves. Using three years of Emergency Department data from a large academic medical center, we developed a boosted tree model that predicts resuscitation within 6 hours of triage, and significantly outperforms existing rule-based sepsis alerts.
PMCID:8861694
PMID: 35308977
ISSN: 1942-597x
CID: 5200392

Optimizing emergency management to reduce morbidity and mortality in pediatric burn patients

Fairbrother, Hilary; Long, Megan; Haines, Elizabeth
Burns are a significant cause of injury-induced morbidity and mortality in pediatric patients. The spectrum of management for pediatric burn victims is vast and relies heavily on both the classification of the burn and the body systems involved. The immediate focus of management includes resuscitation and stabilization, fluid management, and pain control. Additional focus includes decreasing the risk of infection as well as improving healing and cosmetic outcomes. Discharge care and appropriate follow-up instructions need to be communicated carefully in order to avoid long-standing complications. This supplement reviews methods for accurate classification and management of the full range of burns seen in pediatric patients.
PMID: 32530588
ISSN: 1549-9669
CID: 4498752

Points & Pearls: Evaluation and management of pediatric patients with penetrating trauma to the torso

Haines, Elizabeth; Fairbrother, Hilary; Pade, Kathryn H.
Children with penetrating trauma to the torso require careful evaluation of the chest, abdomen, pelvis, and genital structures for system-specific injuries that may contribute to rapid decompensation and influence the order of emergent resuscitation. Care of the injured child and the effect on clinical outcomes starts in the prehospital setting, with hemorrhage control and IV fluid resuscitation. The evaluation and disposition of the patient in the ED will depend on the mechanism of injury and the severity of trauma. This issue reviews the diagnostic evaluation and management of pediatric patients with penetrating injuries to the torso. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice.]
PMID: 31038892
ISSN: 1549-9669
CID: 3854622

Evaluation and management of pediatric patients with penetrating trauma to the torso

Haines, Elizabeth; Fairbrother, Hilary
Children with penetrating trauma to the torso require careful evaluation of the chest, abdomen, pelvis, and genital structures for system-specific injuries that may contribute to rapid decompensation and influence the order of emergent resuscitation. Care of the injured child and the effect on clinical outcomes starts in the prehospital setting, with hemorrhage control and IV fluid resuscitation. The evaluation and disposition of the patient in the ED will depend on the mechanism of injury and the severity of trauma. This issue reviews the diagnostic evaluation and management of pediatric patients with penetrating injuries to the torso.
PMID: 31033268
ISSN: 1549-9669
CID: 3854352

Disorders of the Liver and Biliary Tract

Chapter by: Haines, Elizabeth J; Oyama, Leslie C
in: Rosen's emergency medicine : concepts and clinical practice by Walls, Ron M; Hockberger, Robert S; Gausche-Hill, Marianne [Eds]
Philadelphia, PA : Elsevier, [2018]
pp. 1083-1103
ISBN: 9996111636
CID: 2689662