Academic Pediatrics最新文献

Objective: The growing number of adults with childhood onset chronic conditions (COCC) is reflected in the increase of adult-aged admissions to pediatric institutions. Despite national bodies advising pediatric institutions to have a pediatric to adult health care transition (HCT) policy, little guidance is available on if or how to include inpatient care. We sought to create a framework-based Pediatric to Adult Transitional Care in the Hospital Context (PATCH) tool to assess how inpatient care of adults is addressed in pediatric institutional guidelines or policies (hereafter guidelines) as a first step towards informing future PATCH guideline development.

Methods: We used convenience and snowball sampling to obtain 11 pediatric institutional guidelines. Combining the GotTransition core elements with Coller et al's inpatient transition conceptual model through iterative consensus building, we developed the PATCH tool. Interrater reliability was assessed by using mean percent agreement among raters. A three-phase content validity process utilizing existing guidelines refined the finalized tool.

Results: The PATCH tool included 42 items within nine domains. There was a high degree of agreeability among reviewers, and qualitative analysis revealed no missing items. Twenty-five (59%) of our 42 PATCH tool items were present in at least one of the reviewed guidelines, with age being present in all.

Conclusions: We developed the PATCH tool as a guide for pediatric institutions regarding the care of adolescent and adult patients. The PATCH tool, embedded in multidisciplinary stakeholder discussion and patient- and system-specific knowledge, may help institutions incorporate HCT into processes for adolescent and adult patients with COCCs.

Objective: Suicidal thoughts and behaviors in youth have been increasing over the last 30 years, resulting in recommendations to screen for suicide risk. Our aim was to evaluate suicide risk screenings in children during outpatient care at a specialty care facility for those with neurologic, developmental, and behavioral disorders (NDBDs).

Methods: This cross-sectional, retrospective study utilized suicide screening data from the Ask Suicide-Screening Questions tool administered to children attending initial outpatient visits at medical, behavioral health, or autism specialty clinics serving individuals with NDBDs. Primary outcomes included whether screening occurred or was declined, and if it yielded elevated risk for suicide. Predictive factors were examined.

Results: In total, 15,462 children aged 8 to 17 (38.4% female; 47.7% White, 26.0% Black; 21.0% Medicaid) were offered screening as part of routine care. Overall, 10,970 children underwent screening; 4492 (29.1%) declined. The probability of declined screenings was greater if children were younger, male, attended a medical clinic appointment and were offered the screening prior to the COVID-19 pandemic. The overall rate of positive screening was 10.3%. Children as young as age 8 screened positive in all settings. Positive screening rates in medical, behavioral health, and autism specialty clinics were 7.9%, 12.2%, and 12.7%, respectively. Screenings were more likely to be positive for children who were older, female, self-reported rather than caregiver-reported, and occurring within a behavioral health or autism specialty clinic.

Conclusions: Suicide risk was identified in children across all pediatric programs, indicating strong support for universal suicide screening of children and youth in pediatric settings.

Objective: To determine the association between transgender or gender-questioning identity and cyberbullying victimization in a diverse national sample of early adolescents in the United States.

Methods: We analyzed cross-sectional data from the Adolescent Brain Cognitive Development Study (year 3, 2019-2021, 11-14 years old, 48.8% female, 47.6% racial and ethnic minority). Logistic regression analyses were conducted to estimate the associations between transgender or gender-questioning identity and lifetime cyberbullying victimization, adjusting for sociodemographic confounders.

Results: In a sample of 9989 adolescents (1.0% transgender, 1.1% gender-questioning), both transgender (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.22-4.10) and gender-questioning (OR 1.91, 95% CI 1.05-3.47) adolescents had greater odds of cyberbullying victimization compared to their cisgender peers. There was no evidence of significant effect modification of the association between transgender identity and cyberbullying victimization by sex assigned at birth.

Conclusions: Transgender and gender-questioning early adolescents experience higher rates of cyberbullying victimization than their cisgender peers. Future research could investigate the risk and protective factors for cyberbullying in gender minority adolescents.

Objective: Rapid vital sign assessment, including temperature measurement, is critical among pediatric patients presenting to the emergency department (ED). While error rates in temporal thermometry are well documented, the potential for differential error rates by demographics is not well established. Our objective was to evaluate error rates of temporal thermometers by demographic variables, specifically race and age, among pediatric patients in the ED.

Methods: Pediatric patients (≤18 years old) identified as either Black or White in the medical record presenting to the ED between January 2020 and December 2022 who received at least one paired temperature measurement (temporal and oral/rectal temperature within 30 minutes) were included. Rates of discordance by demographic characteristics were then evaluated. Secondarily, we explored the characteristics of patients who received temporal thermometry only.

Results: The final population included 1526 paired temperatures (1412 patients). Among all paired measurements, 26% had discordant measurements (25% in Black patients vs 26% in White patients). In the final adjusted model, children aged ≤12 years old were found to have 2-3 times higher odds of discordance than children >12 years old. Black patients were statistically significantly more likely to receive a temporal thermometer measurement only (adjusted odds ratio [aOR] 1.27, 95% confidence interval [CI]: 1.22, 1.33), even when controlling for fever-related chief complaints.

Conclusions: Age ≤12 years old was associated with increased odds of missed fever by temporal thermometry. In our secondary analysis, Black patients were found to be more likely to receive temporal thermometry only. These findings highlight the need for consistent, accurate measurement protocols among pediatric patients.

Objective: Approximately one third of caregivers do not obtain a prescribed medication after their child's pediatric emergency department visit. We sought to explore the facilitators and barriers that caregivers experience in accessing prescribed antibiotics after their child's pediatric emergency department visit.

Methods: We conducted semi-structured interviews with caregivers of children who presented to a quaternary academic pediatric emergency department and were discharged with prescribed antibiotics. An interview guide was developed by the study team based on literature review and expert opinion. Interviews were coded, and thematic analysis was performed. Descriptive statistical analysis was used for demographic characteristics and medication pick up rates.

Results: Twenty-two interviews were completed. Caregivers unanimously felt that antibiotics were important. Themes pertaining to medication access included (i) pharmacy location and convenience, (ii) pharmacy efficiency, responsiveness, and medication availability, (iii) impact of receiving first dose of antibiotics in the ED, and (iv) clear verbal and written communication by healthcare providers regarding diagnoses, medication indication and discharge instructions.

Conclusions: Factors contributing to medication access have an underlying theme surrounding convenience and emphasis on the impact of first antibiotic dose administration during ED course. As such, consideration of systems changes that allows caregivers to leave the hospital with the entire course of antibiotics in hand may improve caregiver access to prescribed medications.

Objective: Perinatal marijuana use is common and may be perceived as safer than use of other substances. We evaluated the association between health care provider counseling and maternal marijuana knowledge.

Methods: This multi-state, cross-sectional study was conducted June 2021 to August 2022 at 15 US hospitals in the Better Outcomes through Research for Newborns (BORN) network. A 48-item investigator-developed survey was administered to a convenience sample of postpartum mothers≥21 years giving birth to a newborn≥34 weeks' gestational age and receiving routine mother-baby care. The survey assessed sociodemographics, marijuana use, attitudes and knowledge, and receipt of pre- or post-natal health care provider counseling about perinatal marijuana use. Descriptive statistics were tabulated, and key comparisons were tested using Chi-square analysis and multivariable logistic regression.

Results: Of 484 postpartum mothers, 59.9% endorsed any lifetime marijuana use, while 9.3% reported use during the current pregnancy. Almost 40% reported that in their experience, marijuana use among mothers who are breastfeeding is common or somewhat common. One-third of participants reported receiving any health care provider counseling about marijuana either prenatally or postpartum. Adjusting for covariates, counseling was associated with greater maternal knowledge about risks of perinatal marijuana use to exposed children, including child learning problems (adjusted odds ratio 1.93 [95% confidence interval: 1.13, 3.29]).

Conclusions: A strengthened and standardized approach to health care provider counseling may help to address maternal knowledge gaps about the risks of perinatal marijuana use on exposed newborns and children.

Objective: Burnout is highly prevalent among residents, and although many studied interventions have targeted burnout by trying to promote well-being, it remains a substantial problem. This study utilized data from the Pediatric Resident Burnout-Resilience Study Consortium (PRB-RSC) Annual Burnout Survey to determine which program interventions categorical and noncategorical (medicine-pediatrics and combined programs) pediatric residents found most helpful to promote well-being.

Methods: We conducted a secondary analysis of an open-ended question on the PRB-RSC Annual Burnout Survey in 2019 and 2020: "What is the most helpful thing that your program provides you for wellness?" We performed thematic and content analysis on open-ended responses and compared distribution of themes and subthemes between years using a Chi-square test.

Results: In 2019, 1401 (44%) of 3159 residents from 44 programs responded to the open-ended question, with 771 (49%) of 1563 residents from 21 programs responding in 2020. Residents found wellness interventions within 5 themes to be the most helpful. Promotes positive work environment and Optimizes scheduling were mentioned most frequently, but residents also valued when a program Facilitates traditional wellness interventions, Offers financial benefits, and Prioritizes education. Themes and subthemes were mentioned with the same frequency in both 2019 and 2020.

Conclusions: The results of this study show which institutional interventions residents have found to be most helpful to their well-being. Program leaders can use these data as a framework to discuss interventions with their residents, allowing them to tailor wellness programs and use limited available resources for what residents believe is most impactful.