Pub Date : 2025-01-16DOI: 10.1016/j.acap.2025.102788
Douglas J McLaughlin, Mitchell H Grayson
{"title":"Progress in Removing Inaccurate Penicillin Allergy Labels in the Pediatric Clinic Setting.","authors":"Douglas J McLaughlin, Mitchell H Grayson","doi":"10.1016/j.acap.2025.102788","DOIUrl":"https://doi.org/10.1016/j.acap.2025.102788","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102788"},"PeriodicalIF":3.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-16DOI: 10.1016/j.acap.2025.102786
Bryan S. Monroe MD , Kristina Nazareth-Pidgeon MD , Katherine B. Daniel MS , David Y. Ming MD , Megan Jordan MD , Camille DiCarlo MISE , Anna Spangler MSW , Claire E. Washabaugh MD , Christoph P. Hornik MD, PhD , Mark Chandler MD
Objective
Children with medical complexity (CMC) have disproportionately high health care utilization and mortality. Goals of care (GOC) discussions improve goal concordance and subjective outcomes for CMC and their caregivers; however, little is known about the frequency or characteristics of GOC discussions in CMC. We sought to define GOC discussion frequency and attributes in CMC and identify patient characteristics that may influence GOC discussion occurrence.
Methods
This was a single-institution retrospective cohort study including CMC with at least 1 complex chronic condition (CCC) and 1 hospitalization in 2021. GOC discussion documentation prior to or during 2021 was identified by structured chart review. GOC discussion frequency and attributes were compared by category of patient medical complexity. Patient characteristics were analyzed as predictors of GOC discussion occurrence.
Results
Out of 1235 CMC, documented GOC discussions were uncommon (22%) and 70% occurred in the intensive care unit. In patients who died, 78% of GOC discussions occurred within 6 months of death. In multivariable regression analysis, increased odds of GOC discussion occurrence were observed in CMC who died (P < 0.001), spent fewer days at home (P < 0.001), had ≥4 CCCs or technology dependence (P < 0.001), were uninsured (P = 0.008), or identified as Black (P < 0.001), Hispanic (P = 0.02), or non-Hispanic Other race (P = 0.001).
Conclusions
GOC discussions in CMC were infrequent and typically occurred around critical illness or death. Increased GOC discussion occurrence in racial and ethnic minority CMC may be a proxy for disparate morbidity and mortality and indicates racial and ethnic differences in communication regularity and intensity that warrant further investigation.
{"title":"Goals of Care Discussion Characteristics and Disparities in Children With Medical Complexity","authors":"Bryan S. Monroe MD , Kristina Nazareth-Pidgeon MD , Katherine B. Daniel MS , David Y. Ming MD , Megan Jordan MD , Camille DiCarlo MISE , Anna Spangler MSW , Claire E. Washabaugh MD , Christoph P. Hornik MD, PhD , Mark Chandler MD","doi":"10.1016/j.acap.2025.102786","DOIUrl":"10.1016/j.acap.2025.102786","url":null,"abstract":"<div><h3>Objective</h3><div>Children with medical complexity (CMC) have disproportionately high health care utilization and mortality. Goals of care (GOC) discussions improve goal concordance and subjective outcomes for CMC and their caregivers; however, little is known about the frequency or characteristics of GOC discussions in CMC. We sought to define GOC discussion frequency and attributes in CMC and identify patient characteristics that may influence GOC discussion occurrence.</div></div><div><h3>Methods</h3><div>This was a single-institution retrospective cohort study including CMC with at least 1 complex chronic condition (CCC) and 1 hospitalization in 2021. GOC discussion documentation prior to or during 2021 was identified by structured chart review. GOC discussion frequency and attributes were compared by category of patient medical complexity. Patient characteristics were analyzed as predictors of GOC discussion occurrence.</div></div><div><h3>Results</h3><div>Out of 1235 CMC, documented GOC discussions were uncommon (22%) and 70% occurred in the intensive care unit. In patients who died, 78% of GOC discussions occurred within 6 months of death. In multivariable regression analysis, increased odds of GOC discussion occurrence were observed in CMC who died (<em>P</em> < 0.001), spent fewer days at home (<em>P</em> < 0.001), had ≥4 CCCs or technology dependence (<em>P</em> < 0.001), were uninsured (<em>P</em> = 0.008), or identified as Black (<em>P</em> < 0.001), Hispanic (<em>P</em> = 0.02), or non-Hispanic Other race (<em>P</em> = 0.001).</div></div><div><h3>Conclusions</h3><div>GOC discussions in CMC were infrequent and typically occurred around critical illness or death. Increased GOC discussion occurrence in racial and ethnic minority CMC may be a proxy for disparate morbidity and mortality and indicates racial and ethnic differences in communication regularity and intensity that warrant further investigation.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 4","pages":"Article 102786"},"PeriodicalIF":3.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-15DOI: 10.1016/j.acap.2025.102785
Wei Yi Kong PhD , Melissa B. Gilkey PhD
{"title":"Human Papillomavirus Vaccination at Age 9: Developments and Opportunities in the Field","authors":"Wei Yi Kong PhD , Melissa B. Gilkey PhD","doi":"10.1016/j.acap.2025.102785","DOIUrl":"10.1016/j.acap.2025.102785","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 4","pages":"Article 102785"},"PeriodicalIF":3.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.acap.2025.102780
Melissa R. Lutz MD, MHS , Hollyce Tyrrell MSSW , Mona Sharifi MD, MPH , H. Shonna Yin MD, MS , Barry S. Solomon MD, MPH , Sara B. Johnson PhD, MPH , Amie F. Bettencourt PhD , Eliana M. Perrin MD, MPH
Objectives
To characterize the 1) types of material goods (non-medical items) offered in pediatric residency continuity clinics, 2) consistency of good availability, 3) funding sources used to support supply, 4) whether goods are provided in response to social needs screening, and 5) common challenges with provision. To assess the extent to which provision of goods varied by clinic size and proportion of publicly insured patients.
Methods
Faculty and staff members from clinics in the Academic Pediatric Association’s Continuity Research Network (APA CORNET) completed an online survey about material goods provided in their clinic in the preceding 12 months. Descriptive analyses were performed; Chi-square tests were used to assess differences by clinic size and proportion of publicly insured patients.
Results
Fifty one of 113 eligible programs completed the survey (45%), representing varying clinic sizes and all regions in the United States. All clinics provided books, but reports varied regarding provision of other goods (49% provided food), as did the availability, funding sources, and screening processes for each good. Commonly reported challenges were funding (82%), storage (65%), and sustainability (53%). The types of material goods provided did not vary by clinic size or proportion of publicly insured patients.
Conclusion
This report highlights the range of material goods provided in pediatric continuity clinics and the variability in their availability, funding sources, and screening processes and can serve as the basis for future research to evaluate the impact of material goods provision.
{"title":"Material Goods Provided in Pediatric Primary Care Clinics: A Landscape Analysis","authors":"Melissa R. Lutz MD, MHS , Hollyce Tyrrell MSSW , Mona Sharifi MD, MPH , H. Shonna Yin MD, MS , Barry S. Solomon MD, MPH , Sara B. Johnson PhD, MPH , Amie F. Bettencourt PhD , Eliana M. Perrin MD, MPH","doi":"10.1016/j.acap.2025.102780","DOIUrl":"10.1016/j.acap.2025.102780","url":null,"abstract":"<div><h3>Objectives</h3><div>To characterize the 1) types of material goods (non-medical items) offered in pediatric residency continuity clinics, 2) consistency of good availability, 3) funding sources used to support supply, 4) whether goods are provided in response to social needs screening, and 5) common challenges with provision. To assess the extent to which provision of goods varied by clinic size and proportion of publicly insured patients.</div></div><div><h3>Methods</h3><div>Faculty and staff members from clinics in the Academic Pediatric Association’s Continuity Research Network (APA CORNET) completed an online survey about material goods provided in their clinic in the preceding 12 months. Descriptive analyses were performed; Chi-square tests were used to assess differences by clinic size and proportion of publicly insured patients.</div></div><div><h3>Results</h3><div>Fifty one of 113 eligible programs completed the survey (45%), representing varying clinic sizes and all regions in the United States. All clinics provided books, but reports varied regarding provision of other goods (49% provided food), as did the availability, funding sources, and screening processes for each good. Commonly reported challenges were funding (82%), storage (65%), and sustainability (53%). The types of material goods provided did not vary by clinic size or proportion of publicly insured patients.</div></div><div><h3>Conclusion</h3><div>This report highlights the range of material goods provided in pediatric continuity clinics and the variability in their availability, funding sources, and screening processes and can serve as the basis for future research to evaluate the impact of material goods provision.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 4","pages":"Article 102780"},"PeriodicalIF":3.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-10DOI: 10.1016/j.acap.2025.102776
Elizabeth Nelsen MD , David Mills MD , Nicola Orlov MD, MPH , Nathaniel Goodrich MD , Su-Ting T. Li MD, MPH
Background
The goal of graduate medical education is for residents to achieve the skills and knowledge to practice medicine independently. While remediation is not uncommon in residency training, evidence is lacking to guide best practices.
Methods
We conducted a national survey of pediatric residency programs regarding their remediation experiences identifying struggling residents, documentating the process, and monitoring progress during remediation.
Results
A total of 50.8% (99/195) programs responded. Approximately 4.7% of residents underwent remediation, and 91% (262/288) of residents successfully completed remediation. Programs used data from the Clinical Competency Committee (CCC; 100%), rotation evaluations (98.9%) and direct observation (96.6%) to identify residents who need remediation. Most programs used an improvement plan to document resident progress (88.8%) and assigned a mentor or coach to support the resident (88.8%). Nearly all programs used rotation evaluations (93.3%) to monitor progress towards achieving the goals of remediation. Two-thirds (66.3%) felt their remediation process was either very effective or effective, and about half (56.2%) were very satisfied or satisfied with their remediation process. Programs with more residents who successfully completed remediation were more likely to feel satisfied with their program’s remediation processess and effectiveness.
Conclusions
Nearly 5% of pediatrics residents undergo remediation, with 91% successfully remediating. Two-thirds of program leaders feel their remediation practices are effective, and only half are satisfied with remediation processes in their program. Opportunities exist to improve remediation processes for pediatric residents and for programs to ensure graduation of competent pediatricians.
{"title":"Remediation in Pediatric Residency Training: A National Survey of Pediatric Program Directors","authors":"Elizabeth Nelsen MD , David Mills MD , Nicola Orlov MD, MPH , Nathaniel Goodrich MD , Su-Ting T. Li MD, MPH","doi":"10.1016/j.acap.2025.102776","DOIUrl":"10.1016/j.acap.2025.102776","url":null,"abstract":"<div><h3>Background</h3><div>The goal of graduate medical education is for residents to achieve the skills and knowledge to practice medicine independently. While remediation is not uncommon in residency training, evidence is lacking to guide best practices.</div></div><div><h3>Methods</h3><div>We conducted a national survey of pediatric residency programs regarding their remediation experiences identifying struggling residents, documentating the process, and monitoring progress during remediation.</div></div><div><h3>Results</h3><div>A total of 50.8% (99/195) programs responded. Approximately 4.7% of residents underwent remediation, and 91% (262/288) of residents successfully completed remediation. Programs used data from the Clinical Competency Committee (CCC; 100%), rotation evaluations (98.9%) and direct observation (96.6%) to identify residents who need remediation. Most programs used an improvement plan to document resident progress (88.8%) and assigned a mentor or coach to support the resident (88.8%). Nearly all programs used rotation evaluations (93.3%) to monitor progress towards achieving the goals of remediation. Two-thirds (66.3%) felt their remediation process was either very effective or effective, and about half (56.2%) were very satisfied or satisfied with their remediation process. Programs with more residents who successfully completed remediation were more likely to feel satisfied with their program’s remediation processess and effectiveness.</div></div><div><h3>Conclusions</h3><div>Nearly 5% of pediatrics residents undergo remediation, with 91% successfully remediating. Two-thirds of program leaders feel their remediation practices are effective, and only half are satisfied with remediation processes in their program. Opportunities exist to improve remediation processes for pediatric residents and for programs to ensure graduation of competent pediatricians.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 3","pages":"Article 102776"},"PeriodicalIF":3.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-10DOI: 10.1016/j.acap.2025.102779
Shashwat Kala BA , Madisen A. Swallow MS , Jay Sicklick JD , Yann Poncin MD , Kathryn Meyer JD
The state of pediatric mental health in the United States remains an ongoing challenge. Contributing to this challenge is the biopsychosocial nature of mental health – an interconnected system of biological, psychological, social, and legal factors. Consequently, addressing pediatric mental health requires interdisciplinary collaboration. Medical-legal partnerships (MLPs) integrate legal assistance into traditional health care. Though MLPs have gained momentum in general pediatric health care delivery, they are surprisingly underutilized in the pediatric mental health landscape. This current work highlights the Yale Child Study Center Medical-Legal Partnership Project (YCSC-MLPP), which is to our knowledge, the first MLP in a children’s behavioral health setting in the country. The YCSC-MLPP emerged as an interdisciplinary collaboration between the Yale Schools of Medicine and Law as well as the Center for Children’s Advocacy. Between November 2021 and October 2022, the YCSC-MLPP received 150 referrals regarding patients whose care was complicated by health-harming legal needs. Of these referrals, 70% were non-client consultations, 26% were direct consultation with families, and 4% were full legal representation. The most pertinent topics addressed included education, health, housing, individual rights, and immigration. The creation of the YCSC-MLPP sets an example for what a reimagined, interdisciplinary approach to pediatric mental health can look like.
{"title":"Pediatric Behavioral Health Medical-Legal Partnerships: A Novel Approach to Child and Adolescent Psychiatric Care","authors":"Shashwat Kala BA , Madisen A. Swallow MS , Jay Sicklick JD , Yann Poncin MD , Kathryn Meyer JD","doi":"10.1016/j.acap.2025.102779","DOIUrl":"10.1016/j.acap.2025.102779","url":null,"abstract":"<div><div>The state of pediatric mental health in the United States remains an ongoing challenge. Contributing to this challenge is the biopsychosocial nature of mental health – an interconnected system of biological, psychological, social, and legal factors. Consequently, addressing pediatric mental health requires interdisciplinary collaboration. Medical-legal partnerships (MLPs) integrate legal assistance into traditional health care. Though MLPs have gained momentum in general pediatric health care delivery, they are surprisingly underutilized in the pediatric mental health landscape. This current work highlights the Yale Child Study Center Medical-Legal Partnership Project (YCSC-MLPP), which is to our knowledge, the first MLP in a children’s behavioral health setting in the country. The YCSC-MLPP emerged as an interdisciplinary collaboration between the Yale Schools of Medicine and Law as well as the Center for Children’s Advocacy. Between November 2021 and October 2022, the YCSC-MLPP received 150 referrals regarding patients whose care was complicated by health-harming legal needs. Of these referrals, 70% were non-client consultations, 26% were direct consultation with families, and 4% were full legal representation. The most pertinent topics addressed included education, health, housing, individual rights, and immigration. The creation of the YCSC-MLPP sets an example for what a reimagined, interdisciplinary approach to pediatric mental health can look like.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 3","pages":"Article 102779"},"PeriodicalIF":3.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-10DOI: 10.1016/j.acap.2025.102784
Jason M Nagata, Zain Memon, Jonanne Talebloo, M P H Karen Li, Patrick Low, Iris Y Shao, Kyle T Ganson, Alexander Testa, Jinbo He, Claire D Brindis, Fiona C Baker
Objective: To describe patterns of social media use, including underage (under 13 years) use and sex differences, in a diverse, national sample of early adolescents in the U.S.
Methods: We analyzed the social media use data in the Adolescent Brain Cognitive Development Study (2019-2021, Year 3), which includes a national sample of early adolescents in the U.S. Specifically, using chi-squared and t-tests, we compared social media use patterns across demographic characteristics stratified by age and sex.
Results: In the sample of 10,092 11-to-15-year-old adolescents, 69.5% had at least one social media account; among social media users, the most common platforms were TikTok (67.1%), YouTube (64.7%), and Instagram (66.0%). A majority (63.8%) of participants under 13 years (minimum age requirement) reported social media use. Under-13 social media users had an average of 3.38 social media accounts, with 68.2% having TikTok accounts and 39.0% saying TikTok was the social media site they used the most. Females reported higher use of TikTok, Snapchat, Instagram, and Pinterest, while males reported higher use of YouTube and Reddit. Additionally, 6.3% of participants with social media accounts reported having a secret social media account hidden from their parents' knowledge.
Conclusion: Our findings reveal a high prevalence rate of underage social media use in early adolescence. These findings can inform current policies and legislation aimed at more robust age verification measures, minimum age requirements, and the enhancement of parental controls on social media. Clinicians can counsel about the potential risks of early adolescent social media use.
What's new: In a sample of 10,092 U.S. early adolescents, a majority (63.8%) of participants under 13 years old (minimum age requirement) reported social media use. Under-13 social media users had an average of 3.38 social media accounts.
{"title":"Prevalence and Patterns of Social Media Use in Early Adolescents.","authors":"Jason M Nagata, Zain Memon, Jonanne Talebloo, M P H Karen Li, Patrick Low, Iris Y Shao, Kyle T Ganson, Alexander Testa, Jinbo He, Claire D Brindis, Fiona C Baker","doi":"10.1016/j.acap.2025.102784","DOIUrl":"10.1016/j.acap.2025.102784","url":null,"abstract":"<p><strong>Objective: </strong>To describe patterns of social media use, including underage (under 13 years) use and sex differences, in a diverse, national sample of early adolescents in the U.S.</p><p><strong>Methods: </strong>We analyzed the social media use data in the Adolescent Brain Cognitive Development Study (2019-2021, Year 3), which includes a national sample of early adolescents in the U.S. Specifically, using chi-squared and t-tests, we compared social media use patterns across demographic characteristics stratified by age and sex.</p><p><strong>Results: </strong>In the sample of 10,092 11-to-15-year-old adolescents, 69.5% had at least one social media account; among social media users, the most common platforms were TikTok (67.1%), YouTube (64.7%), and Instagram (66.0%). A majority (63.8%) of participants under 13 years (minimum age requirement) reported social media use. Under-13 social media users had an average of 3.38 social media accounts, with 68.2% having TikTok accounts and 39.0% saying TikTok was the social media site they used the most. Females reported higher use of TikTok, Snapchat, Instagram, and Pinterest, while males reported higher use of YouTube and Reddit. Additionally, 6.3% of participants with social media accounts reported having a secret social media account hidden from their parents' knowledge.</p><p><strong>Conclusion: </strong>Our findings reveal a high prevalence rate of underage social media use in early adolescence. These findings can inform current policies and legislation aimed at more robust age verification measures, minimum age requirements, and the enhancement of parental controls on social media. Clinicians can counsel about the potential risks of early adolescent social media use.</p><p><strong>What's new: </strong>In a sample of 10,092 U.S. early adolescents, a majority (63.8%) of participants under 13 years old (minimum age requirement) reported social media use. Under-13 social media users had an average of 3.38 social media accounts.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"102784"},"PeriodicalIF":3.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-09DOI: 10.1016/j.acap.2025.102777
Sabrina M. Darwiche MD, MPH , Cindy W. Christian MD , Cody-Aaron L. Gathers MD, MSHP , Ryan W. Morgan MD, MTR , Maryam Y. Naim MD, MSCE , Joanne N. Wood MD, MSHP
Objective
In children admitted after an out-of-hospital cardiac arrest (OHCA), this study 1) determines the proportion that undergo physical abuse and toxin exposure evaluation, child protection team (CPT) consultation, and child protective services (CPS) referral, and 2) evaluates the association between demographic, social, clinical characteristics with CPT consultation and CPS referral.
Methods
A retrospective chart review was conducted of children <4 years old admitted following an OHCA between November 2012 and February 2023. Associations between demographics, caregiver social risk factors, and clinical characteristics with CPT consultation and CPS referral were examined using logistic regression.
Results
Among 157 cases, 70 (45%) had skeletal surveys; 8 (11%) identified an occult fracture. Seventy-five (48%) children had toxicology testing; 16 of the 75 (21%) revealed a toxic ingestion. Sixteen of the 49 (33%) patients receiving ophthalmologic evaluations had significant retinal hemorrhages. Seventy-seven (49%) patients had a CPT consultation, while 74 (47%) were referred to CPS. A history concerning for ingestion perfectly predicted CPT consultation. History of ingestion, injury on exam, positive skeletal survey, and positive toxicology testing perfectly predicted CPS referral. In multivariate analyses, unsafe sleep history (84% versus 41%, P < 0.001) and caregiver social risk factors (82% versus 31%, P < 0.001) were associated with CPT consultation, while caregiver social risk factors (70% versus 34%, P < 0.001) and normal medical work-up (53% versus 38%, P = 0.050) were associated with CPS referral.
Conclusions
Following OHCA, a child maltreatment evaluation may be underutilized with medical decision-making around CPT consultation and CPS referral driven by knowledge of caregiver social risk factors.
{"title":"Child Maltreatment Evaluations Following Out-of-Hospital Cardiac Arrests","authors":"Sabrina M. Darwiche MD, MPH , Cindy W. Christian MD , Cody-Aaron L. Gathers MD, MSHP , Ryan W. Morgan MD, MTR , Maryam Y. Naim MD, MSCE , Joanne N. Wood MD, MSHP","doi":"10.1016/j.acap.2025.102777","DOIUrl":"10.1016/j.acap.2025.102777","url":null,"abstract":"<div><h3>Objective</h3><div>In children admitted after an out-of-hospital cardiac arrest (OHCA), this study 1) determines the proportion that undergo physical abuse and toxin exposure evaluation, child protection team (CPT) consultation, and child protective services (CPS) referral, and 2) evaluates the association between demographic, social, clinical characteristics with CPT consultation and CPS referral.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted of children <4 years old admitted following an OHCA between November 2012 and February 2023. Associations between demographics, caregiver social risk factors, and clinical characteristics with CPT consultation and CPS referral were examined using logistic regression.</div></div><div><h3>Results</h3><div>Among 157 cases, 70 (45%) had skeletal surveys; 8 (11%) identified an occult fracture. Seventy-five (48%) children had toxicology testing; 16 of the 75 (21%) revealed a toxic ingestion. Sixteen of the 49 (33%) patients receiving ophthalmologic evaluations had significant retinal hemorrhages. Seventy-seven (49%) patients had a CPT consultation, while 74 (47%) were referred to CPS. A history concerning for ingestion perfectly predicted CPT consultation. History of ingestion, injury on exam, positive skeletal survey, and positive toxicology testing perfectly predicted CPS referral. In multivariate analyses, unsafe sleep history (84% versus 41%, <em>P</em> < 0.001) and caregiver social risk factors (82% versus 31%, <em>P</em> < 0.001) were associated with CPT consultation, while caregiver social risk factors (70% versus 34%, <em>P</em> < 0.001) and normal medical work-up (53% versus 38%, <em>P</em> = 0.050) were associated with CPS referral.</div></div><div><h3>Conclusions</h3><div>Following OHCA, a child maltreatment evaluation may be underutilized with medical decision-making around CPT consultation and CPS referral driven by knowledge of caregiver social risk factors.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 3","pages":"Article 102777"},"PeriodicalIF":3.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-09DOI: 10.1016/j.acap.2025.102778
Chelsey B. Anderson PhD , Isabella K. Pallotto MPH , Lindsay Dominguez BS , Mary Anne Ammon MS , Adam Carle MA, PhD , Ellen A. Lipstein MD, MPH
Objective
Shared decision making (SDM) involving adolescents presents unique challenges. To adequately support and evaluate SDM that includes adolescents, parents, and health care providers, it is imperative to understand adolescent perspectives. This study aims to describe the perspectives of adolescents with chronic health conditions regarding sharing medical decisions with their parents and health care providers.
Methods
Adolescents ages 12 to 17 years with chronic health conditions participated in semistructured qualitative interviews via video conference. Interview questions focused on adolescents’ decision-making experiences. Additionally, concepts of SDM were explored in depth. Transcribed interviews were coded and thematically analyzed using a combination of inductive and deductive coding.
Results
Sixteen adolescents participated in qualitative interviews (median age 14 years, 62% male, 62% non-white). Analysis of interviews revealed 4 themes that highlight adolescent perspectives on the process of SDM: defining the adolescent’s role and degree of participation in decisions, understanding complex information, sharing the adolescent’s unique perspective, and coming to consensus. Adolescents in this study described increasingly active participation in more complex decisions as they gained independence, experience, and understanding of health information. Adolescents discussed the importance of their perspectives being acknowledged in the final decision. They also felt it was important to identify values they have in common with their parents and health care providers.
Conclusions
Results from this work indicate that adolescents with chronic health conditions experience evolving roles in SDM. These data can be used to tailor and improve SDM to address adolescent needs through active engagement, personalized communication, and inclusion of adolescent values.
{"title":"Evolving Roles: Adolescent Perspectives on Shared Decision Making With Their Parents and Health Care Providers","authors":"Chelsey B. Anderson PhD , Isabella K. Pallotto MPH , Lindsay Dominguez BS , Mary Anne Ammon MS , Adam Carle MA, PhD , Ellen A. Lipstein MD, MPH","doi":"10.1016/j.acap.2025.102778","DOIUrl":"10.1016/j.acap.2025.102778","url":null,"abstract":"<div><h3>Objective</h3><div>Shared decision making (SDM) involving adolescents presents unique challenges. To adequately support and evaluate SDM that includes adolescents, parents, and health care providers, it is imperative to understand adolescent perspectives. This study aims to describe the perspectives of adolescents with chronic health conditions regarding sharing medical decisions with their parents and health care providers.</div></div><div><h3>Methods</h3><div>Adolescents ages 12 to 17 years with chronic health conditions participated in semistructured qualitative interviews via video conference. Interview questions focused on adolescents’ decision-making experiences. Additionally, concepts of SDM were explored in depth. Transcribed interviews were coded and thematically analyzed using a combination of inductive and deductive coding.</div></div><div><h3>Results</h3><div>Sixteen adolescents participated in qualitative interviews (median age 14 years, 62% male, 62% non-white). Analysis of interviews revealed 4 themes that highlight adolescent perspectives on the process of SDM: <em>defining the adolescent’s role and degree of participation in decisions, understanding complex information, sharing the adolescent’s unique perspective</em>, and <em>coming to consensus.</em> Adolescents in this study described increasingly active participation in more complex decisions as they gained independence, experience, and understanding of health information. Adolescents discussed the importance of their perspectives being acknowledged in the final decision. They also felt it was important to identify values they have in common with their parents and health care providers.</div></div><div><h3>Conclusions</h3><div>Results from this work indicate that adolescents with chronic health conditions experience evolving roles in SDM. These data can be used to tailor and improve SDM to address adolescent needs through active engagement, personalized communication, and inclusion of adolescent values.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 4","pages":"Article 102778"},"PeriodicalIF":3.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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