Pub Date : 2025-11-01Epub Date: 2025-07-09DOI: 10.1016/j.jpeds.2025.114716
Florens Lohrmann, Markus Hufnagel, Maren Doenhardt, Natalie Diffloth, Sarah Christina Goretzki, Christian Dohna-Schwake, Stefan Arens, Juergen Brunner, Katja Reineker, Delphina Gomes, Jakob Armann, Reinhard Berner, André Jakob
Objective: To investigate the intermediate-term health impacts of pediatric inflammatory multisystem syndrome temporally-associated with SARS-CoV-2 (PIMS-TS).
Study design: Using a standardized questionnaire in a multicenter study, follow-up data from acute PIMS-TS patients were collected, including detailed information on patient characteristics, clinical progression, laboratory findings, imaging results, and outcomes. These follow-up data were then linked to data from the patients' acute-phase PIMS disease, as recorded in the German (and Innsbruck, Austria) PIMS-TS registry.
Results: Of the 920 cases originally documented in the acute-phase PIMS-TS registry, follow-up data were collected from 6 pediatric centers on 127 patients; 81 patients were male. Mean age during the acute phase was 8 years (SD: 4.4 years). Median follow-up time was 125 days (IQR: 50.5 to 290.5 days). Overall, a majority of patients achieved full recovery, with 81/127 doing so even before their first follow-up visit. However, abnormal echocardiographic findings continued in 18/67 patients. Coronary dilatation persisted in 14/33 (42%) and resolved in all but 3. Residual cardiovascular and general symptoms were more frequent in older children, as well as among those who had required intensive care unit treatment during the acute phase.
Conclusion: Our findings confirm the generally favorable intermediate-term outcome in patients with PIMS-TS. However, a subset of patients in our cohort, particularly older children and those requiring intensive care unit care during the acute phase, experienced prolonged symptoms, especially cardiovascular complications. Close follow-up and multidisciplinary care are recommended in order to monitor these patients' recovery.
{"title":"Recovery from Pediatric Inflammatory Multisystem Syndrome Temporally-Associated with SARS-CoV-2: Follow-Up from a Nationwide German Cohort.","authors":"Florens Lohrmann, Markus Hufnagel, Maren Doenhardt, Natalie Diffloth, Sarah Christina Goretzki, Christian Dohna-Schwake, Stefan Arens, Juergen Brunner, Katja Reineker, Delphina Gomes, Jakob Armann, Reinhard Berner, André Jakob","doi":"10.1016/j.jpeds.2025.114716","DOIUrl":"10.1016/j.jpeds.2025.114716","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the intermediate-term health impacts of pediatric inflammatory multisystem syndrome temporally-associated with SARS-CoV-2 (PIMS-TS).</p><p><strong>Study design: </strong>Using a standardized questionnaire in a multicenter study, follow-up data from acute PIMS-TS patients were collected, including detailed information on patient characteristics, clinical progression, laboratory findings, imaging results, and outcomes. These follow-up data were then linked to data from the patients' acute-phase PIMS disease, as recorded in the German (and Innsbruck, Austria) PIMS-TS registry.</p><p><strong>Results: </strong>Of the 920 cases originally documented in the acute-phase PIMS-TS registry, follow-up data were collected from 6 pediatric centers on 127 patients; 81 patients were male. Mean age during the acute phase was 8 years (SD: 4.4 years). Median follow-up time was 125 days (IQR: 50.5 to 290.5 days). Overall, a majority of patients achieved full recovery, with 81/127 doing so even before their first follow-up visit. However, abnormal echocardiographic findings continued in 18/67 patients. Coronary dilatation persisted in 14/33 (42%) and resolved in all but 3. Residual cardiovascular and general symptoms were more frequent in older children, as well as among those who had required intensive care unit treatment during the acute phase.</p><p><strong>Conclusion: </strong>Our findings confirm the generally favorable intermediate-term outcome in patients with PIMS-TS. However, a subset of patients in our cohort, particularly older children and those requiring intensive care unit care during the acute phase, experienced prolonged symptoms, especially cardiovascular complications. Close follow-up and multidisciplinary care are recommended in order to monitor these patients' recovery.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114716"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jpeds.2025.114884
Lukas K. Gaffney MD, MPH , Kenneth A. Michelson MD, MPH , Michael C. Monuteaux ScD , John Porter MBA , Joel Hudgins MD, MPH
Objectives
To examine the association between social determinants of health and location of pediatric low-resource-intensity visits, and to quantify associated reimbursement.
Study design
We performed a cross-sectional, nationally representative survey study of nonelective visits for patients ≤18 years old in the 2019-2021 Medical Expenditure Panel Survey. The primary outcome was emergency department (ED) or outpatient location of low-resource-intensity visits (visits with no labs, imaging, procedures, or resultant hospitalization). The relationship between location and social determinants was determined with logistic regression. The secondary outcome was reimbursement related to these visits.
Results
A total of 23 231 observations representing 96 155 173 visits were included. Of these, 3.2% were to the ED. Among social determinants of health, lower education, public insurance, and lack of primary care were associated with ED presentation; family income and language were not. Reimbursement for ED visits was 544.3% higher than outpatient visits, accounting for $546 million in yearly excess health care costs.
Conclusions
Lower family educational attainment, public insurance status, and poor access to primary care demonstrated significant associations with ED presentation for low-resource-intensity visits. These results suggest that interventions to reduce these visits, which could improve disparities and reduce unnecessary medical spending, should address modifiable factors such as access to primary care.
{"title":"Individual Social Determinants of Health and Location of Pediatric Low-Resource-Intensity Care","authors":"Lukas K. Gaffney MD, MPH , Kenneth A. Michelson MD, MPH , Michael C. Monuteaux ScD , John Porter MBA , Joel Hudgins MD, MPH","doi":"10.1016/j.jpeds.2025.114884","DOIUrl":"10.1016/j.jpeds.2025.114884","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine the association between social determinants of health and location of pediatric low-resource-intensity visits, and to quantify associated reimbursement.</div></div><div><h3>Study design</h3><div>We performed a cross-sectional, nationally representative survey study of nonelective visits for patients ≤18 years old in the 2019-2021 Medical Expenditure Panel Survey. The primary outcome was emergency department (ED) or outpatient location of low-resource-intensity visits (visits with no labs, imaging, procedures, or resultant hospitalization). The relationship between location and social determinants was determined with logistic regression. The secondary outcome was reimbursement related to these visits.</div></div><div><h3>Results</h3><div>A total of 23 231 observations representing 96 155 173 visits were included. Of these, 3.2% were to the ED. Among social determinants of health, lower education, public insurance, and lack of primary care were associated with ED presentation; family income and language were not. Reimbursement for ED visits was 544.3% higher than outpatient visits, accounting for $546 million in yearly excess health care costs.</div></div><div><h3>Conclusions</h3><div>Lower family educational attainment, public insurance status, and poor access to primary care demonstrated significant associations with ED presentation for low-resource-intensity visits. These results suggest that interventions to reduce these visits, which could improve disparities and reduce unnecessary medical spending, should address modifiable factors such as access to primary care.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114884"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jpeds.2025.114887
Kayla Covert PT, DPT , Brittany Davis MS , Kendall Hammonds MPH , Taylor Gilliland MS , Nicholas Douville MD , Simon Driver PhD , Morgan O'Neil PhD
Objective
To examine clinic-based health care use (HU) patterns (prolonged use, accessibility continuity, comprehensiveness, and intensity) in children with acute and subacute concussion.
Study design
This retrospective cohort study included patients aged 5-17 years receiving specialty care at an interdisciplinary sports concussion clinic. Patients were dichotomized on the basis of index visit chronicity: acute (≤3 days) and subacute (>3 days) postinjury. Prolonged HU, the primary outcome, was defined as having any follow-up visit >28 days from the index visit. Other measures of HU (accessibility [distance from clinic, insurance status], continuity [visit pacing], comprehensiveness [number and type of referrals], and intensity [number of follow-up visits]) as well as recovery and treatment time were obtained. Multivariable regressions were completed using confounders based upon established literature.
Results
Of 622 patients, 362 (58.2%) presented acutely and 260 (41.8%) subacutely. The acute group was more likely to have a history of motion sickness (P = .02), a sport-related mechanism of injury (P = .006), and migrainous presentation (P = .0005), whereas the subacute group was slightly older (P = .002). Despite differences in presentation timing, no significant differences were observed in prolonged HU (P = .17), distance from clinic (P = .41), or insurance status (P = .36). However, patients in the acute group had significantly lower pacing of visits (ie, continuity; P < .001) with greater number of follow-ups (ie, intensity; P < .001) but were less likely to receive interdisciplinary referrals (P < .001). After adjusting for confounding clinical variables, no significant differences in treatment duration were observed between the two groups (P = .90).
Conclusions
Initiation of concussion care within 1 week of injury demonstrates comparable effectiveness regardless of exact timing, although early presentation favors single-provider management whereas later presentation requires enhanced interdisciplinary coordination.
{"title":"Examining Clinic-Based Health Care Use Patterns in a Specialty Concussion Care Setting","authors":"Kayla Covert PT, DPT , Brittany Davis MS , Kendall Hammonds MPH , Taylor Gilliland MS , Nicholas Douville MD , Simon Driver PhD , Morgan O'Neil PhD","doi":"10.1016/j.jpeds.2025.114887","DOIUrl":"10.1016/j.jpeds.2025.114887","url":null,"abstract":"<div><h3>Objective</h3><div>To examine clinic-based health care use (HU) patterns (prolonged use, accessibility continuity, comprehensiveness, and intensity) in children with acute and subacute concussion.</div></div><div><h3>Study design</h3><div>This retrospective cohort study included patients aged 5-17 years receiving specialty care at an interdisciplinary sports concussion clinic. Patients were dichotomized on the basis of index visit chronicity: acute (≤3 days) and subacute (>3 days) postinjury. Prolonged HU, the primary outcome, was defined as having any follow-up visit >28 days from the index visit. Other measures of HU (accessibility [distance from clinic, insurance status], continuity [visit pacing], comprehensiveness [number and type of referrals], and intensity [number of follow-up visits]) as well as recovery and treatment time were obtained. Multivariable regressions were completed using confounders based upon established literature.</div></div><div><h3>Results</h3><div>Of 622 patients, 362 (58.2%) presented acutely and 260 (41.8%) subacutely. The acute group was more likely to have a history of motion sickness (<em>P</em> = .02), a sport-related mechanism of injury (<em>P</em> = .006), and migrainous presentation (<em>P</em> = .0005), whereas the subacute group was slightly older (<em>P</em> = .002). Despite differences in presentation timing, no significant differences were observed in prolonged HU (<em>P</em> = .17), distance from clinic (<em>P</em> = .41), or insurance status (<em>P</em> = .36). However, patients in the acute group had significantly lower pacing of visits (ie, continuity; <em>P</em> < .001) with greater number of follow-ups (ie, intensity; <em>P</em> < .001) but were less likely to receive interdisciplinary referrals (<em>P</em> < .001). After adjusting for confounding clinical variables, no significant differences in treatment duration were observed between the two groups (<em>P</em> = .90).</div></div><div><h3>Conclusions</h3><div>Initiation of concussion care within 1 week of injury demonstrates comparable effectiveness regardless of exact timing, although early presentation favors single-provider management whereas later presentation requires enhanced interdisciplinary coordination.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114887"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jpeds.2025.114883
Luke R. Allen PhD , Cody G. Dodd PhD , Christine N. Moser PsyD , Michelle M. Knoll MD
Objective
To examine changes in suicidality following hormone therapy (HT) among transgender and gender-diverse adolescents and young adults.
Study design
A retrospective chart review was conducted at a multidisciplinary gender health clinic with 432 patients (mean follow-up = 679 days) completing the Ask Suicide-Screening Questions before and after treatment initiation. A repeated-measures ANCOVA assessed within-person changes in suicidality over time, adjusting for age at treatment and treatment duration.
Results
Suicidality significantly declined from pretreatment to post-treatment (F[1, 426] = 34.63, P < .001, partial η2 = 0.075). This effect was consistent across sex assigned at birth, age at start of therapy, and treatment duration.
Conclusions
HT was associated with clinically meaningful reductions in suicidality over time, extending prior findings with a larger sample and longer follow-up. These study findings provide clinical evidence supporting the mental health benefits of timely access to HT in this population.
目的：探讨跨性别和性别多样化的青少年和年轻人在激素治疗（HT）后自杀率的变化。研究设计：在一家多学科性别健康诊所对432名患者（平均随访= 679天）在治疗开始前后完成自杀筛查问题（ASQ）进行回顾性图表回顾。重复测量ANCOVA评估随时间的个人自杀率变化，调整治疗时的年龄和治疗持续时间。结果：治疗前后自杀率显著下降（F[1,426] = 34.63, P < 0.001，偏η2 = 0.075）。这种效应在出生时的性别、治疗开始时的年龄和治疗持续时间中都是一致的。结论：随着时间的推移，HT与临床意义上的自杀率降低有关，通过更大的样本和更长的随访扩展了先前的发现。这些研究结果提供了临床证据，支持在这一人群中及时获得治疗对心理健康有益。
{"title":"Changes in Suicidality among Transgender Adolescents Following Hormone Therapy: An Extended Study","authors":"Luke R. Allen PhD , Cody G. Dodd PhD , Christine N. Moser PsyD , Michelle M. Knoll MD","doi":"10.1016/j.jpeds.2025.114883","DOIUrl":"10.1016/j.jpeds.2025.114883","url":null,"abstract":"<div><h3>Objective</h3><div>To examine changes in suicidality following hormone therapy (HT) among transgender and gender-diverse adolescents and young adults.</div></div><div><h3>Study design</h3><div>A retrospective chart review was conducted at a multidisciplinary gender health clinic with 432 patients (mean follow-up = 679 days) completing the Ask Suicide-Screening Questions before and after treatment initiation. A repeated-measures ANCOVA assessed within-person changes in suicidality over time, adjusting for age at treatment and treatment duration.</div></div><div><h3>Results</h3><div>Suicidality significantly declined from pretreatment to post-treatment (<em>F</em>[1, 426] = 34.63, <em>P</em> < .001, partial η<sup>2</sup> = 0.075). This effect was consistent across sex assigned at birth, age at start of therapy, and treatment duration.</div></div><div><h3>Conclusions</h3><div>HT was associated with clinically meaningful reductions in suicidality over time, extending prior findings with a larger sample and longer follow-up. These study findings provide clinical evidence supporting the mental health benefits of timely access to HT in this population.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114883"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jpeds.2025.114882
Vincent Julien Chessex , Florence Anne Barbey MD , Patrick Haberstich , Henrik Köhler MD, MHBA , Dimitri Christian Michel Vetterli MD
Objective
To assess whether and when comprehensive respiratory viral testing contributes to risk stratification and management of febrile young infants (FYI).
Study design
Single-center, retrospective cohort study of hospitalized FYI, aged ≤90 days (born at term) or ≤52 6/7 postmenstrual weeks (born preterm), over a 5-year period. A total of 456 infants with either a positive respiratory viral test result, regardless of diagnostic assay, or a negative respiratory viral test result obtained by comprehensive panel were included in the final analysis. Main outcomes were serious bacterial infection (SBI) rates overall and in specific subsamples, stratified by viral test results. Rates were estimated assuming a binomial distribution, with confidence intervals derived from a normal approximation. Risk ratios with 95% confidence intervals were calculated using uncertainty propagation.
Results
Among 456 FYI (mean age 41 days), 70 (15.4%) had SBI, including 6 cases of bacteremia and 1 of meningitis. Infants with a positive viral test result had an SBI rate of 11.9% (42/354), including 2 cases of bacteremia, with significantly lower rates observed only in those testing positive for influenza (6%) and respiratory syncytial virus (4%). Regardless of viral test results, 93% (65/70) of SBI cases had abnormal inflammatory markers or urinalysis. Invasive bacterial infections occurred in both virus-positive (2/354) and virus-negative infants (5/102).
Conclusions
Comprehensive respiratory viral testing appears to have limited value for SBI risk stratification in FYI. It does not seem to support clinical decision-making or replace established risk stratification by inflammatory markers and urinalysis. Targeted testing may represent a more appropriate use of resources.
{"title":"Limitations of Comprehensive Respiratory Viral Testing in Managing Young Infants with Fever","authors":"Vincent Julien Chessex , Florence Anne Barbey MD , Patrick Haberstich , Henrik Köhler MD, MHBA , Dimitri Christian Michel Vetterli MD","doi":"10.1016/j.jpeds.2025.114882","DOIUrl":"10.1016/j.jpeds.2025.114882","url":null,"abstract":"<div><h3>Objective</h3><div>To assess whether and when comprehensive respiratory viral testing contributes to risk stratification and management of febrile young infants (FYI).</div></div><div><h3>Study design</h3><div>Single-center, retrospective cohort study of hospitalized FYI, aged ≤90 days (born at term) or ≤52 6/7 postmenstrual weeks (born preterm), over a 5-year period. A total of 456 infants with either a positive respiratory viral test result, regardless of diagnostic assay, or a negative respiratory viral test result obtained by comprehensive panel were included in the final analysis. Main outcomes were serious bacterial infection (SBI) rates overall and in specific subsamples, stratified by viral test results. Rates were estimated assuming a binomial distribution, with confidence intervals derived from a normal approximation. Risk ratios with 95% confidence intervals were calculated using uncertainty propagation.</div></div><div><h3>Results</h3><div>Among 456 FYI (mean age 41 days), 70 (15.4%) had SBI, including 6 cases of bacteremia and 1 of meningitis. Infants with a positive viral test result had an SBI rate of 11.9% (42/354), including 2 cases of bacteremia, with significantly lower rates observed only in those testing positive for influenza (6%) and respiratory syncytial virus (4%). Regardless of viral test results, 93% (65/70) of SBI cases had abnormal inflammatory markers or urinalysis. Invasive bacterial infections occurred in both virus-positive (2/354) and virus-negative infants (5/102).</div></div><div><h3>Conclusions</h3><div>Comprehensive respiratory viral testing appears to have limited value for SBI risk stratification in FYI. It does not seem to support clinical decision-making or replace established risk stratification by inflammatory markers and urinalysis. Targeted testing may represent a more appropriate use of resources.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114882"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jpeds.2025.114879
Sophi R. Lederer MD , Desiree N. Neville MD , Fran Balamuth MD, PhD, MSCE , Laura L. Chapman MD , Amy D. Thompson MD, MSCR , Meagan M. Ladell MD , Anupam B. Kharbanda MD, MSc , Michael C. Monuteaux ScD , Lise E. Nigrovic MD, MPH , for Pedi Lyme Net
In our longitudinal cohort of 385 children with peripheral facial nerve palsy, 7 of 145 (4.8%; 95% CI 2.4-9.6%) with Lyme disease did not initially receive appropriate antibiotics and 98 of 240 (40.8%; 95% CI 34.8-47.2%) with idiopathic facial palsy received antibiotics unnecessarily. A rapid and accurate Lyme diagnostic could improve initial treatment.
在我们的385名周围面神经麻痹儿童纵向队列中，7/145 （4.8%;95% CI 2.4-9.6%）莱姆病患者最初没有接受适当的抗生素治疗，98/240 （40.8%;95% CI 34.8-47.2%）特发性面神经麻痹患者接受了不必要的抗生素治疗。快速准确的莱姆病诊断可以改善初始治疗。
{"title":"A Longitudinal Cohort Study of Children with Peripheral Facial Nerve Palsy in Lyme Disease Endemic Areas","authors":"Sophi R. Lederer MD , Desiree N. Neville MD , Fran Balamuth MD, PhD, MSCE , Laura L. Chapman MD , Amy D. Thompson MD, MSCR , Meagan M. Ladell MD , Anupam B. Kharbanda MD, MSc , Michael C. Monuteaux ScD , Lise E. Nigrovic MD, MPH , for Pedi Lyme Net","doi":"10.1016/j.jpeds.2025.114879","DOIUrl":"10.1016/j.jpeds.2025.114879","url":null,"abstract":"<div><div>In our longitudinal cohort of 385 children with peripheral facial nerve palsy, 7 of 145 (4.8%; 95% CI 2.4-9.6%) with Lyme disease did not initially receive appropriate antibiotics and 98 of 240 (40.8%; 95% CI 34.8-47.2%) with idiopathic facial palsy received antibiotics unnecessarily. A rapid and accurate Lyme diagnostic could improve initial treatment.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114879"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-07-18DOI: 10.1016/j.jpeds.2025.114744
Christopher P Duggan
{"title":"Adverse Effects on Child Health from United States Retrenchment on Global Scientific Collaboration: Examples from Gastroenterology, Hepatology, and Nutrition.","authors":"Christopher P Duggan","doi":"10.1016/j.jpeds.2025.114744","DOIUrl":"10.1016/j.jpeds.2025.114744","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114744"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01Epub Date: 2025-07-18DOI: 10.1016/j.jpeds.2025.114735
Mayanka Chandrashekar, Jordan Tschida, Jeffrey R Strawn, Heidi A Hanson, Daniel Santel, Ian Goethert, Anuj J Kapadia, Tracy Glauser, John Pestian, Greeshma A Agasthya
Objective: To compare the utilization patterns of expert vocabulary (EVo) in diagnosing pediatric anxiety between mental health and non-mental health clinical notes from electronic health records to understand the role of Evo in informing classification and decision-making in anxiety diagnoses.
Study design: We conducted a retrospective study using a cohort less than age 25 from Cincinnati Children's Hospital including 897 685 patients with 61 586 446 notes. We analyzed EVo, collected from mental health clinicians, in both mental and nonmental health notes. We compared classification accuracy using EVo-based patient-level embedding from all clinical notes, mental-health notes, and nonmental health notes for 2 tasks: 1) pre-vs postdiagnosis anxiety patients, and 2) prediagnosis anxiety vs nonanxiety patients.
Results: EVo usage was highest in prediagnosis anxiety, lower in nonanxiety, and lowest in post-diagnosis. Classification models using EVo features from all, mental-health, and non-mental health notes showed similar F1 scores for prediagnosis anxiety (0.70 ± 0.2 for 2 categories). For anxiety vs nonanxiety classification, all clinical and nonmental health notes had better F1 scores than mental-health notes (above 0.90 for 3 categories). There was a notable difference in class-wise performance across both tasks.
Conclusions: There are significant differences in anxiety EVo use between mental health and nonmental health clinicians. Despite less anxiety-specific terminology, non-mental health notes still captured key aspects of patient presentations, emphasizing the importance of including all clinicians' notes in analysis. EVo's utility for anxiety classification is most effective in prediagnostic phases, suggesting the need for a dedicated diagnostic lexicon and further study before incorporating EVo into classification models.
{"title":"Comparison of Expert Vocabulary Usage Patterns Between Mental Health and Nonmental Health Clinicians When Diagnosing Pediatric Anxiety Disorders.","authors":"Mayanka Chandrashekar, Jordan Tschida, Jeffrey R Strawn, Heidi A Hanson, Daniel Santel, Ian Goethert, Anuj J Kapadia, Tracy Glauser, John Pestian, Greeshma A Agasthya","doi":"10.1016/j.jpeds.2025.114735","DOIUrl":"10.1016/j.jpeds.2025.114735","url":null,"abstract":"<p><strong>Objective: </strong>To compare the utilization patterns of expert vocabulary (EVo) in diagnosing pediatric anxiety between mental health and non-mental health clinical notes from electronic health records to understand the role of Evo in informing classification and decision-making in anxiety diagnoses.</p><p><strong>Study design: </strong>We conducted a retrospective study using a cohort less than age 25 from Cincinnati Children's Hospital including 897 685 patients with 61 586 446 notes. We analyzed EVo, collected from mental health clinicians, in both mental and nonmental health notes. We compared classification accuracy using EVo-based patient-level embedding from all clinical notes, mental-health notes, and nonmental health notes for 2 tasks: 1) pre-vs postdiagnosis anxiety patients, and 2) prediagnosis anxiety vs nonanxiety patients.</p><p><strong>Results: </strong>EVo usage was highest in prediagnosis anxiety, lower in nonanxiety, and lowest in post-diagnosis. Classification models using EVo features from all, mental-health, and non-mental health notes showed similar F1 scores for prediagnosis anxiety (0.70 ± 0.2 for 2 categories). For anxiety vs nonanxiety classification, all clinical and nonmental health notes had better F1 scores than mental-health notes (above 0.90 for 3 categories). There was a notable difference in class-wise performance across both tasks.</p><p><strong>Conclusions: </strong>There are significant differences in anxiety EVo use between mental health and nonmental health clinicians. Despite less anxiety-specific terminology, non-mental health notes still captured key aspects of patient presentations, emphasizing the importance of including all clinicians' notes in analysis. EVo's utility for anxiety classification is most effective in prediagnostic phases, suggesting the need for a dedicated diagnostic lexicon and further study before incorporating EVo into classification models.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114735"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jpeds.2025.114889
Tara A. Lavelle PhD , Jill L. Maron MD , Stephen F. Kingsmore MD , Ching-Hsuan Lin MD , Yingying Zhu PhD , Benjamin Sweigart MA , Dallas Reed MD , Bruce D. Gelb MD , Jerry Vockley MD, PhD , Jonathan M. Davis MD
Objective
To compare 1-year health care costs and quality-adjusted life years (QALYs) for 2 diagnostic strategies in critically ill infants with suspected genetic disorders: 1) early rapid genome sequencing (rGS; within 7 days of admission) for all infants, and 2) early targeted neonatal gene sequencing (NewbornDx) for all infants, followed by later rGS (after 7 days) for undiagnosed infants.
Study design
The Genomic Medicine for Ill Neonates and Infants study was a multicenter, prospective study that enrolled 400 hospitalized infants under 1 year of age with suspected genetic disorders. All participants underwent both rGS and NewbornDx. Using patient-level Genomic Medicine for Ill Neonates and Infants data and 2023 Medicare rates, we developed a decision tree to compare total costs and QALYs over a 1-year period for these 2 hypothetical testing strategies.
Results
The diagnostic yield and upfront testing costs were higher for rGS (49%; $12,297) than NewbornDx (27%; $2449; P < .05). As neither early testing nor diagnosis significantly affected QALYs, we conducted a cost-minimization analysis, focusing solely on cost differences between strategies. Over 1 year, early rGS was estimated to save $158,592 per patient (95% CI: $63,701-$253,292) compared with early NewbornDx with later rGS if necessary.
Conclusions
Early rGS results in substantial health care cost savings, highlighting the need to expand reimbursement to improve access early in a hospitalization for critically ill infants.
{"title":"Rapid Genome Sequencing Compared with a Gene Panel in Critically Ill Infants with a Suspected Genetic Disorder: An Economic Evaluation","authors":"Tara A. Lavelle PhD , Jill L. Maron MD , Stephen F. Kingsmore MD , Ching-Hsuan Lin MD , Yingying Zhu PhD , Benjamin Sweigart MA , Dallas Reed MD , Bruce D. Gelb MD , Jerry Vockley MD, PhD , Jonathan M. Davis MD","doi":"10.1016/j.jpeds.2025.114889","DOIUrl":"10.1016/j.jpeds.2025.114889","url":null,"abstract":"<div><h3>Objective</h3><div>To compare 1-year health care costs and quality-adjusted life years (QALYs) for 2 diagnostic strategies in critically ill infants with suspected genetic disorders: 1) early rapid genome sequencing (rGS; within 7 days of admission) for all infants, and 2) early targeted neonatal gene sequencing (NewbornDx) for all infants, followed by later rGS (after 7 days) for undiagnosed infants.</div></div><div><h3>Study design</h3><div>The Genomic Medicine for Ill Neonates and Infants study was a multicenter, prospective study that enrolled 400 hospitalized infants under 1 year of age with suspected genetic disorders. All participants underwent both rGS and NewbornDx. Using patient-level Genomic Medicine for Ill Neonates and Infants data and 2023 Medicare rates, we developed a decision tree to compare total costs and QALYs over a 1-year period for these 2 hypothetical testing strategies.</div></div><div><h3>Results</h3><div>The diagnostic yield and upfront testing costs were higher for rGS (49%; $12,297) than NewbornDx (27%; $2449; <em>P</em> < .05). As neither early testing nor diagnosis significantly affected QALYs, we conducted a cost-minimization analysis, focusing solely on cost differences between strategies. Over 1 year, early rGS was estimated to save $158,592 per patient (95% CI: $63,701-$253,292) compared with early NewbornDx with later rGS if necessary.</div></div><div><h3>Conclusions</h3><div>Early rGS results in substantial health care cost savings, highlighting the need to expand reimbursement to improve access early in a hospitalization for critically ill infants.</div></div><div><h3>Trial registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> Identifier: <span><span>NCT03890679</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114889"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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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