Hospital pediatrics最新文献

Background: Fatal opioid overdoses among children have increased 4-fold since 2018, driven by unintentional fentanyl overdoses in adolescents. Detailed descriptions profiling nonfatal overdoses that present to emergency departments (EDs) amidst this surge in deaths are lacking.

Methods: We performed a retrospective cross-sectional study of the Pediatric Health Information System, an administrative database of tertiary-care children's hospitals. We included children and youths aged 0 to 19 years who had an ED visit for opioid overdose from 2017 to 2022 using International Classification of Diseases, Tenth Revision codes. We excluded incomplete encounters. We examined temporal trends using Poisson regression models or quasi-Poisson models if data was overdispersed.

Results: We identified 4550 ED visits for opioid overdose. ED visits for opioid overdose rose 20.2% (incidence rate ratio [IRR], 1.0001; P < .001) from 2017 to 2022. Increases were highest among patients aged 0 to 4 and 15 to 19 years; male; those self-identifying as Black, Hispanic or multiracial; urban; and publicly insured. Children aged 0 to 4 and 15 to 19 years accounted for most visits (45.7% and 35.2%, respectively). Although synthetic opioid overdoses increased (IRR, 1.0002; P < .001) and were the predominant agent among children aged 0 to 4 years, prescription opioid overdoses were more common overall. Most adolescent overdoses were intentional. Rates of intensive care admission increased (IRR, 1.0004; P < .001). Fatal overdoses rose 200% (IRR, 1.0008; P = .02).

Conclusion and relevance: Increasing numbers of children are presenting to pediatric EDs for opioid overdose and in increasingly critical condition. Unlike fatal overdoses, most pediatric ED visits are for young children experiencing synthetic opioid overdose and adolescents with intentional prescription opioid overdose.

Objective: The birth hospitalization for infants prenatally substance-exposed (IPSEs) is a critical opportunity to connect with families and optimize the transition of care from inpatient to outpatient settings. Through qualitative interviews with clinicians and clinical staff, we sought to identify multilevel factors that impact care transitions from birth hospital to home for IPSEs and their families.

Methods: We recruited inpatient and outpatient clinicians and clinical staff (N = 17) from hospitals participating in the Colorado Hospital Substance Exposed Newborn Quality Improvement Collaborative (CHoSEN QIC), a state-based perinatal quality initiative focused on standardizing the care of IPSEs, for semistructured interviews. Multiple coders engaged in inductive thematic analysis, using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to generate thematic memos across participants.

Results: We identified facilitators and barriers within and across levels of the outer and inner context. Outer-context themes included the need for standardized patient identification, integrated care systems for effective transitions, and sociopolitical context, including challenges with changing laws and lagging policies. Inner-context themes included the value of rapport building with families, optimization of medical team communication, critical role of nonmedical team members for care coordination, and the importance of early identification of discharge disposition.

Conclusions: Participants across inner and outer contexts highlighted the importance of de-siloing clinical care groups serving families affected by substance use, including the need for enhanced communication among groups and the importance of incorporating key nonmedical personnel. Integrating care and communication across systems will be crucial next steps for optimization of care of this population.