Academic Pediatrics最新文献

Objective: To externally validate two prediction models for pediatric radiographic pneumonia.

Methods: We prospectively evaluated the performance of two prediction models (Pneumonia Risk Score [PRS] and CARPE DIEM models) from a prospective convenience sample of children 90 days - 18 years of age from a pediatric emergency department undergoing chest radiography for suspected pneumonia between January 1, 2022, to December 31^st, 2023. We evaluated model performance using the original intercepts and coefficients and evaluated for performance changes when performing recalibration and re-estimation procedures.

Results: We included 202 patients (median age 3 years, IQR 1-6 years), of whom radiographic pneumonia was found in 92 (41.0%). The PRS model had an area under the receiver operator characteristic curve of 0.72 (95% confidence interval [CI] 0.64-0.79), which was higher than the CARPE DIEM (0.59; 95% CI 0.51-0.67) (P<0.01). Using optimal cutpoints, the PRS model showed higher sensitivity (65.2%, 95% CI 54.6-74.9) and specificity (72.7%, 95% CI 63.4-80.8) compared to the CARPE DIEM model (sensitivity 56.5 [95% CI 45.8-66.8]; specificity 60.9 [95% CI 50.2-69.2]). Recalibration and re-estimation of models improved performance, particularly for the CARPE DIEM model, with gains in sensitivity and specificity, and improved calibration.

Conclusion: The PRS model demonstrated better performance than the CARPE DIEM model in predicting radiographic pneumonia. Among children with a high rate of pneumonia, these models did not reach a level of performance sufficient to be used independently of clinical judgement. These findings highlight the need for further validation and improvement of models to enhance their utility.

Objective: Mental health diagnoses among adolescents are increasing in prevalence. Existing literature considers associations between individual-level social determinants of health (SDOH) and adolescent mental health. Yet, neighborhood-level SDOH can have a substantial impact on health. This paper examines associations between neighborhood-level SDOH and mental health diagnoses of anxiety, depression, and suicidal ideation among hospitalized adolescents.

Methods: We used 2018 and 2019 Texas Inpatient Discharge Public Use Data Files linked to the zip-code level Child Opportunity Index 2.0, a composite measure of subdomains which characterize neighborhood-level SDOH, to examine rates of mental health diagnoses and associations with patient characteristics across opportunity level quintiles.

Results: The sample included 50,011 adolescents ages 10-19 admitted to the hospital with the mental health diagnoses anxiety, depression, and/or suicide. Most had a single diagnosis; anxiety (12.9%), depression (37.5%), or suicide (13.0%). Hospitalized adolescents 10 to 14 years old were a plurality (44.2%) of the sample. Most adolescents were White (64.2%) and non-Hispanic (67.4%) and lived in rural areas (29.6%). Adolescents from racial minority populations and those in rural communities with mental health diagnoses had lower opportunity-levels. Higher opportunity levels were associated with greater odds of having an anxiety or suicide diagnosis while a depression diagnosis was associated with a lower opportunity-level.

Conclusions: There are significant differences in adolescent mental health diagnoses associated with neighborhood opportunity-level. While all adolescents can benefit from mental health education, screening, and early interventions, additional resources tailored to neighborhood-level opportunity may prove a more meaningful way to improve population-level mental health outcomes.

Objective: To determine disparities in adverse childhood experiences (ACEs) by sexual identity in a national cohort of early adolescents.

Methods: We analyzed cross-sectional data from year 2 of the Adolescent Brain Cognitive Development Study (N=10,934, 2018-2020, ages 10-14 years). Disparities in ACE score across lesbian, gay, or bisexual (LGB), not sure, and heterosexual adolescents were assessed using multinomial logistic regression analyses. Logistic regressions estimated the associations between sexual identity and each individual ACE. Analyses were adjusted for potential confounders.

Results: In adjusted models, LGB adolescents had higher risk of experiencing 2, 3, or ≥4 ACEs (Relative Risk Ratios [RRR] =1.57, 95% CI 1.01-2.42), 3 (RR=1.78, 95% CI 1.100-2.88), or ≥4 ACEs (RRR=3.20, 95% CI 1.92-5.32), and not sure adolescents had a higher risk of having ≥4 ACEs (RRR=2.17, 95% CI 1.22-3.87), compared to heterosexual adolescents. LGB and not sure adolescents had higher risks of reporting emotional abuse ("yes" OR =4.21, 95% CI 1.84-9.61; "maybe" OR=6.20, 95% CI 2.91-13.19) and parent mental illness ("yes" OR=1.95, 95% CI 1.48-2.57; "maybe" OR=1.63, 95% CI 1.21-2.18) compared to heterosexual adolescents.

Conclusions: LGB adolescents and those questioning their sexual identity were at greater risk of having higher ACE scores, with LGB adolescents experiencing the highest risk of experiencing ACEs. LGB adolescents also had higher odds of reporting emotional and parent mental illness. Recognizing this heightened risk of ACEs in early adolescence is critical for designing clinic and school-based interventions.

Objective: To evaluate the efficacy of Resident Education And Counseling on Household (REACH) Firearm Safety, a novel virtual reality (VR) intervention.

Methods: We conducted a single-center, randomized controlled trial among pediatric residents in a Midwestern academic primary care center comparing REACH Firearm Safety with didactic training (intervention) to didactic training alone (control). In the intervention arm, participants practiced firearm safety counseling with virtual characters and received immediate feedback. All residents completed audio-recorded standardized patient (SP) encounters before and after the training as well as a retrospective pre-post survey. Two reviewers, blinded to allocation arm, used a standardized assessment tool to generate performance scores. Outcomes of interest included the difference between groups in SP performance scores and self-reported confidence.

Results: From March to July 2023, 62% of eligible pediatric residents (n=47/76) completed the allocated study tasks (Intervention 19, Control 28). In both groups, SP performance scores and self-reported confidence improved. Compared to the control group, the intervention group demonstrated improvement in sharing information on secure storage devices (p=0.009) and increased confidence on providing information on secure storage (p=0.002).

Conclusion: Compared with didactic training alone, a VR intervention using deliberate practice improved residents' skills and confidence related to firearm safety counseling.

Objective: To promote public speaking skills, a pediatrics residency program developed a longitudinal public speaking curriculum grounded in deliberate practice and reflective practice.

Methods: Residents delivered annual presentations and received formal feedback. Audience evaluation forms from 2005-2017 were included for analysis. The form used 5-point scales (5= best) for specific presentation elements (clarity, eye contact/body language, pace, succinct text, minimally distracting delivery, clear conclusion, appropriate learning objectives, achieving learning objectives, and answering questions) and for overall quality. Longitudinal changes in scores were analyzed with paired t tests.

Results: Overall, 5,771 evaluations of 276 presentations given by 97 residents were analyzed. Between post-graduate year (PGY)-1 and PGY-3 presentations, mean overall rating increased from 4.38 to 4.59 (P<.001, d=0.51). The median percentage of 5-point scores increased from 50.0% (IQR, 24.3%-65.4%) to 72.5% (IQR, 53.3%-81.2%). Eight of 9 specific elements showed significant increases (median effect size 0.55). Residents whose initial presentations ranked in the bottom quartile had larger improvements than residents initially ranked in the top quartile.

Conclusions: After pediatric residents participated in a public speaking curriculum with targeted objectives, formal feedback, and repeated practice, their public speaking skills improved. Public speaking curricula can and should be adopted more broadly in graduate medical education.

Background: There are persistent structural barriers that threaten inclusion and retention of underrepresented in medicine (UIM) residents and fellows (trainees) as future faculty in academic medicine. We developed the Leadership Education in Advancing Diversity (LEAD) Program at a single, academic institution, to address these barriers through a 10-month longitudinal curriculum across GME for trainees to develop leadership and scholarship skills in DEI.

Objective: Explore how participation in LEAD impacted UIM trainees' sense of belonging and professional identity formation in academic medicine; as well as perceptions about pursuing a career in academic medicine and future leadership roles.

Methods: IRB-approved qualitative study in August 2020-August 2021 with individual, semi-structured interviews of UIM LEAD graduates from the first 4 cohorts (2017-2021). Data were analyzed by two authors using modified grounded theory.

Results: 14 UIM trainees were interviewed; seven themes emerged. Critical aspects of the program: (1) Creation of a community of shared DEI values (2) Mentorship (3) Role of allies. Results of the program: (4) Deepened appreciation of personal and professional identity as UIM (5) Fostered belonging in academic medicine (6) Appreciation of different careers in academic medicine and how to integrate DEI interests (7) Inspired trainees to pursue leadership roles.

Conclusions: LEAD can serve as a model for other institutions that seek to support UIM trainees' sense of belonging, professional identity formation, and perceptions about pursuing careers in academic medicine and future leadership roles.

Objective: The closure of inpatient pediatric units within general hospitals has contributed to the regionalization of pediatric care. For children in rural areas, the distance traveled for hospitalization impacts the quality of care for children, the impact upon families, and the preparedness for disaster planning within rural communities. We assessed trends in location of hospitalization over time for rural-residing children.

Methods: Using the Healthcare Cost and Utilization Project's State Inpatient Databases, we studied 256,947 hospitalizations for rural-residing children 0-17 years of age within eight states (CO, FL, KY, NC, NJ, NY, OR, WA) from 2002-2017. Level of rurality was defined by Rural-Urban Commuting Area Codes: micropolitan, small rural, and isolated rural. Birth, psychiatric, and surgical hospitalizations were excluded. Trends in number of hospitalizations by hospital location, interfacility transfer (IFT), and whether the hospital location was the same level of rurality as the patient's home residence were assessed with the Cochran-Armitage trend test.

Results: From 2002 to 2017, hospitalizations for rural-residing children decreased by 52.7% (56,168 to 26,548) and IFTs increased from 6.7% to 26.5% (p<.001). The proportion of total hospitalizations within metropolitan areas for rural-residing children increased from 32.2% to 72.8% (p<.001). Local-area agreement between the patient's residence and hospital utilized decreased from 53.6% to 21.5% (p<.001).

Conclusions: Although overall hospitalizations for rural-residing children decreased, IFTs increased, and the proportion hospitalized in metropolitan areas increased. The impact of this shift in inpatient health services on efficiency and quality of care for rural-residing children needs further exploration.

Objective: To evaluate the association between postpartum depression (PPD) screening results in pediatric primary care and subsequent infant preventive and acute care utilization.

Methods: This was a retrospective cohort analysis of 5,341 infants born in 2021 whose mothers were screened for PPD at a well-child visit during the first 6 months. Logistic regression was used to examine that association between a positive PPD screen and 1) adherence to the 12-month well-child visit, and 2) any acute care visits (urgent care or emergency department visits) from 6-15 months. The association between PPD screen and number of acute care visits was examined with negative binomial logistic regression.

Results: The incidence of positive PPD screens was 15.6% in the first 6 months. There was no significant difference in 12-month well-child visit adherence based on PPD screening (adjusted odds ratio (aOR): 0.91; 95% confidence interval (CI): 0.77 to 1.06; p-value: 0.206). The odds of having any acute care visit were higher among infants whose mothers screened positive for PPD (aOR: 1.2; 95% CI: 1.0 to 1.3; p-value: 0.009). There was a significant difference in the incidence rate of acute care visits based on PPD screening results (incidence rate ratio: 1.1; 95% CI: 1.0 to 1.2; p-value: 0.005).

Conclusions: Screening positive for PPD was associated with subsequent acute care utilization but not 12-month preventive care. Primary care providers may need to proactively follow-up after acute care visits to ensure both infant health and maternal needs are met, connecting mothers to resources as needed.