Hospital pediatrics最新文献

Objective: Health care environments pose risks to both patients and care providers. This study investigates unit working conditions potentially impacting patient and provider safety concurrently to identify common risk factors for targeted interventions.

Methods: Zero-inflated negative binomial models analyzed associations between select working conditions (eg, overtime, patient census) and patient/employee safety event rates. Multivariable regression models explored adjusted effects.

Results: Patient and employee safety event rates showed little correlation, with units having higher rates in one category often showing lower rates in the other. Significant associations were found between safety events and select working conditions; however, results were inconsistent across indicators and did not apply uniformly to both safety event types.

Conclusions: Although patient and employee safety event rates were not correlated, evidence suggests common factors (unit group, registered nurse vacancy) jointly influence both outcomes. Further research on specific safety outcomes may reveal more causal associations.

Context: Procedural care in pediatric emergency departments (PEDs) frequently involves painful and anxiety-provoking interventions such as fracture reductions and laceration repairs. These experiences can result in significant psychological impacts, including long-term anxiety and posttraumatic stress.

Objective: To systematically map existing pediatric procedural experience measures in PEDs, focusing on pain, anxiety, and satisfaction associated with both pharmacological and nonpharmacological interventions.

Data sources: A comprehensive search was conducted across the MEDLINE, Embase, and Web of Science databases from inception to August 28, 2024. Additional references were identified through citation searching.

Study selection: All forms of primary research assessing pediatric procedural experiences, including both pharmacological and nonpharmacological interventions in emergency or urgent care settings, were eligible. Conference abstracts were included if sufficient data were available.

Data extraction: Data were extracted using a custom extraction form. A narrative synthesis was performed, comparing demographic characteristics, interventions, and outcome measures.

Results: A total of 143 studies were included, with 82.5% focusing on pharmacological interventions and 14.7% on nonpharmacological strategies. Under half (45.1%) of reported outcomes included child self-reports. Satisfaction measures were predominantly caregiver-focused, and qualitative methods were employed in just 3.5% of studies.

Conclusions: This review highlights the need for standardized frameworks integrating pain, anxiety, and satisfaction measures while prioritizing child perspectives. Current approaches often overlook emotional and psychological dimensions, relying on clinician- or caregiver-focused assessments and quantitative measures. Future research should prioritize the development of multidimensional, child-reported experience frameworks that integrate pain, anxiety, and satisfaction to guide more emotionally supportive and trauma-informed pediatric procedural care.

Background: Suicidal thoughts and behaviors (STBs) among pre-adolescents are increasing at alarming rates in the United States, with notable differences based on race, ethnicity, and sex, but little is known about nonfatal STBs in the group.

Methods: We conducted a retrospective analysis of STB-related encounters among youth aged 6 through 12 using nationally representative US hospital data from 2020 to 2022, drawn from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample. Demographic and clinical characteristics were analyzed, as were type of STB (suicidal ideation, intentional overdose, asphyxiation, etc), classified using International Classification of Diseases, Tenth Revision diagnosis codes. National-level census denominators were used to calculate trends in rates of STB-related encounters as well as national and regional rates by racial/ethnic and sex subgroups.

Results: The majority of patients with STB (78.9%) had a code indicating only suicidal ideation as the reason for the encounter. Girls were 2.10 times more likely than boys to have an ED encounter for any STB (95% CI 2.06-2.14) and were 9.14 times more likely than boys to have an ED encounter for prescription drug overdose (95% CI 8.31-10.06). Over the 3-year study period, there were increasing trends in encounter rates for all groups, but the largest increases were seen among minoritized girls.

Discussion: There is an urgent need for a safety net of care so that caregivers of children with suicide risk have options other than the hospital for acute treatment of suicidal ideation and behaviors. Culturally responsive services are critical to addressing this public health crisis.

Objective: Pediatric somatic symptom and related disorders (SSRDs) negatively impact patients' lives and can lead to hospitalization. No national U.S. studies have examined inpatient SSRD prevalence and health care utilization. We aimed to report demographic characteristics and health care utilization of patients admitted for pediatric SSRDs using the Pediatric Health Information System (PHIS) and identify characteristics associated with high utilization.

Methods: We included inpatient encounters from 2016 through 2023 for patients 5 to 21 years old with an admitting or primary SSRD diagnosis. We used descriptive statistics to summarize patient- and encounter-level variables and multivariable logistic regression to identify factors independently associated with high utilization (readmission or >75th percentile length of stay [LOS] or cost).

Results: There were 6820 encounters and 6297 patients from 48 hospitals. Most patients were 12 to 18 years old (n = 4889, 78%), female (74%, n = 4666), and non-Hispanic white (55%, n = 3449). Median LOS was 2 days (IQR, 1-4), and median encounter cost was $7946 (IQR, 4737-13 701). Four hundred sixteen patients (7%) had multiple admissions. Carrying 7 or more diagnoses and Northeast hospitalization were associated with higher odds of prolonged LOS, high cost, and readmission. Odds of prolonged LOS alone were higher with commercial insurance (odds ratio [OR], 1.19 [95% CI, 1.03-1.36]) and comorbid anxiety (OR, 1.29 [95% CI, 1.10-1.51]). Hispanic patients had higher odds of high-cost admission (OR, 1.57 [95% CI, 1.24-1.99]) compared with non-Hispanic white patients.

Conclusions: An average of 853 admissions for SSRDs occur annually across 48 US tertiary care children's hospitals and affect a sociodemographically diverse population. Further investigation into drivers of disparate health care utilization is needed.

Background: Elevated blood lead levels are still prevalent among children in the United States, and there continue to be published reports of severe childhood lead poisoning across the United States. However, the epidemiology of hospital encounters for severe lead poisoning is still unknown.

Methods: We included encounters for children with a primary diagnosis of lead poisoning using Pediatric Hospital Information System data from 2016 to 2023. We used descriptive statistics to characterize patient sociodemographic factors, clinical characteristics, and hospital utilization, as well as Poisson regression accounting for hospital state-level variation, to estimate lead poisoning rates by patient race and ethnicity, insurance payor, urbanicity, and Childhood Opportunity Index (COI) level.

Results: There were 845 inpatient hospitalizations and 1137 emergency department visits for lead poisoning across 47 hospitals, resulting in over $4.5 million mean cumulative annual billed charges. Compared with patients who identified as white, non-Hispanic, patients who identified as Asian, non-Hispanic (incidence rate ratio [IRR], 1.75); Black, non-Hispanic (IRR, 1.44); and multiracial, non-Hispanic (IRR, 2.26) had significantly higher rates of lead poisoning encounters. Those with public insurance had higher rates of encounters compared with those with commercial insurance (IRR, 2.14). Patients in rural zip codes had significantly higher rates of encounters than patients in urban zip codes (IRR, 1.51). Patients in low- (IRR, 1.79) and very low-COI (IRR, 3.22) zip codes had significantly higher rates of encounters compared with those in very high-COI zip codes.

Conclusions: This study finds that severe lead poisoning remains a substantial health concern. We found significant disparities in the rate of encounters by sociodemographic factors that warrant further action.

Background: Asthma exacerbations are a leading cause of pediatric hospitalization, and systemic corticosteroids are a mainstay of inpatient treatment. This study describes hospital-level variability and trends in systemic corticosteroid prescribing during acute asthma exacerbation hospitalizations and examines hospital-level associations between prescribed corticosteroid and hospitalization outcomes.

Methods: This retrospective cross-sectional study used the Pediatric Health Information System database to examine encounters of patients aged 2 to 18 years who were hospitalized with an acute asthma exacerbation between January 1, 2016, and December 31, 2023 and were administered dexamethasone, prednisone, prednisolone, or methylprednisolone. We analyzed trends and hospital-level variation in systemic corticosteroid prescribing. We used generalized estimating equations to analyze the association of annual hospital-level dexamethasone use with hospitalization outcomes-length of stay, ED revisit, and readmission rates, with models adjusted for relevant clinical and demographic factors.

Results: We identified 122 856 asthma hospitalizations across 38 children's hospitals. From 2016 to 2023, the proportion of hospital-level dexamethasone use increased from 42% to 77%. The proportion of hospitals prescribing dexamethasone for over 80% of hospital encounters rose from 18% in 2016 to 66% in 2023. There was no difference in hospitalization outcomes based on annual hospital-level dexamethasone use, including a subanalysis also based on annual hospital-level dexamethasone use focusing on exclusive dexamethasone or exclusive prednisone/prednisolone use (P > .05).

Conclusions: Dexamethasone use during asthma hospitalizations increased during the study period, without differences in hospitalization outcomes between hospitals that used a higher proportion of dexamethasone vs those that used less.

Objective: Pediatric emergency transfers (ETs), unplanned intensive care unit (ICU) transfers in which a child needs intubation, vasopressor initiation, or at least 60 mL/kg fluid resuscitation within 1 hour, are associated with longer stays and higher mortality, yet their financial burden is unknown. Thus, we compared post-transfer financial charges for ETs vs non-ETs.

Patients and methods: We conducted a retrospective cohort study of 2034 ICU transfers between 2015 and 2019 at a freestanding children's hospital. We compared charges between ETs and non-ETs, including aggregate post-transfer ICU charges (transfer through ICU discharge), aggregate total post-transfer hospital charges (transfer through 100 days post-transfer), and average daily post-transfer charges over the first 100 days. Charge comparisons were adjusted for age, presence of complex chronic conditions, pretransfer length of stay, originating service, and deterioration type using regression models with generalized estimating equations.

Results: Compared to non-ETs, ETs had higher unadjusted post-transfer charges (ICU: 108% [95% CI 51-188], P < .01; total: 91% [95% CI 50-143], P < .01; daily: 61% [95% CI 35-91], P < .01). After adjustment, ETs remained associated with higher post-transfer charges (ICU: 65% [95% CI 22-123], P < .01); total: 49% [95% CI 17-90], P < .01; daily: 20% [95% CI 3-98], P = .02). ET-associated post-transfer charge increases varied significantly by originating service (general pediatrics: 104% [95% CI 30-221] vs surgical services: -19% [95% CI -55 to 47], P < .01) and deterioration type (respiratory: 177% [52%-407%] vs circulatory: 2% [-28% to 47%], P < .01).

Conclusions: ETs are associated with significantly higher post-transfer charges for hospitalized children. This financial impact highlights the economic imperative, alongside clinical benefits, for investing in systems aimed at preventing delayed escalation and reducing ETs.

Objective: Fentanyl is an opioid analgesic commonly used for pain management in children who are critically ill. However, fentanyl use is discouraged during extracorporeal membrane oxygenation (ECMO) because of its lipophilic and protein-binding properties. These properties have been shown to increase the risk of opioid withdrawal and other poor health outcomes. Our objectives were to evaluate institutional variation and the factors associated with fentanyl use for children on ECMO.

Patients and methods: This retrospective study included children aged less than 18 years who received ECMO between 2016 to 2023 at children's hospitals in the Pediatric Health Information System. Multivariable hierarchical logistic regression evaluated factors associated with fentanyl prescribing during ECMO.

Results: Overall, 7731 children (54.5% male, 53.8% white, 48.6% neonatal) were included, with 91.9% receiving fentanyl during ECMO. Significant institutional variability was observed, with percent days of fentanyl use during ECMO ranging from 13.4% to 100%. Overall, 20.3% of the total variation in fentanyl use on ECMO was attributable to differences among hospitals. On multivariable regression, compared with adolescents, neonates (odds ratio [OR], 2.35; 95% CI, 1.61-3.43) had the highest likelihood of receiving fentanyl. Additionally, children with cardiovascular disease (OR, 1.63; 95% CI, 1.35-1.95) had an increased likelihood of receiving fentanyl, and children with a history of prematurity (OR, 0.50; 95% CI, 0.38-0.66) had a decreased likelihood.

Conclusion: Despite its known risks, fentanyl remains widely used for children on ECMO. Additionally, significant institutional variation exists, with neonates having the highest risk of fentanyl exposure. Our findings underscore the need for enhanced guidelines for sedation and pain management for children receiving ECMO.