Journal of hospital medicine最新文献

Background: Children with new-onset psychosis often require hospitalization for medical evaluation.

Objectives: The goal of this study was to assess variations in the management of children with new-onset psychosis and characterize trends in resource utilization.

Methods: The study included index hospitalizations for children ages 7-18 admitted to children's hospitals with a primary diagnosis of psychosis from 2011 to 2022 using the Pediatric Health Information System (PHIS) database. Children with a complex chronic condition were excluded. Resource utilization categories included medication, imaging, laboratory, and other clinical resources. Variability in resource utilization was assessed using covariance tests for random intercepts with generalized linear modes after adjusting for age, sex, payor, and severity. Trends in resource utilization were examined using generalized estimating equations adjusting for the same factors and accounting for hospital clustering.

Results: Our data set included 7126 new-onset psychosis hospitalizations from 37 children's hospitals. Teenage males and non-Hispanic Whites were most likely to be hospitalized. There was a significant variation in resource utilization across hospitals in all categories (p < .001). The most frequently utilized resources were antipsychotic medications (76%), serum chemistry (77%), toxicology labs (72%), and brain magnetic resonance imaging (22%). The most notable increases in utilization were in the performance of laboratory tests, brain imaging, anesthetic use, and intravenous immunoglobulin use.

Conclusion: Study findings suggest that there has been a stable rate of hospitalization for children with new-onset psychosis, yet a significant variation in the medical evaluation exists. Significant increases and variations in resource utilization across all categories suggest an emerging need for robust evidence and consensus-based practice guidelines.

In this second part of a series on medical debt and the costs of care, we examine the past and present financial protections for low-income patients at nonprofit hospitals. Born of almshouses and religious orders, nonprofit hospitals were devoted at their founding to the care of the poor. However, over the course of the twentieth century, they became more focused on high-priced care for paying patients. Federal regulations surrounding tax exemption and charity care have been loosened to allow hospitals to spend relatively little on financial assistance, contributing to inequitable and inadequate financial protections for low-income patients.

Dizziness is a common clinical presentation that incurs huge financial costs. It is frequently misdiagnosed due to a wide differential involving both benign (inner ear disease) and serious (stroke) disorders. Traditional frameworks that emphasize symptom quality (dizziness/lightheadedness/vertigo) lack diagnostic utility. This Clinical Progress Note reviews the literature on acute dizziness evaluation in adult patients and presents an evidence-based framework for hospitalists to diagnose the majority of undifferentiated dizzy patients at the bedside. Future research should assess the validity of this approach with hospitalists' ability to accurately diagnose dizzy patients, and its impact on patient care and healthcare outcomes.

An improved understanding of patient-related violent events toward healthcare workers (HCWs) is a critical step in mitigating patient violence in the pediatric medical hospital setting. Therefore, we sought to describe the timing/setting, potential antecedents to, and management of pediatric patient-related violence toward HCW. Using our electronic health record (EHR), we performed a retrospective study of patient-related physical violent events from 2017 to 2022 among youth hospitalized at our free-standing children's hospital. We identified 144 violent events associated with 75 patients. Most (66.7%) events occurred after a youth was medically cleared for discharge, and most (55%) events were preceded by an aversive experience the youth was trying to avoid. Most (77.1%) youth received medications for de-escalation, and nearly one-half (47.9%) experienced mechanical restraints. Our results highlight the challenges hospitals face while caring for youth at risk for behavioral escalations and support the need for both comprehensive in-patient behavioral health teams.

Administrative databases are powerful tools for pediatric research but lack patient-level microbiology results. This study aimed to determine the accuracy of pathogen discharge diagnosis codes for children hospitalized with acute hematogenous musculoskeletal infections (MSKIs). Medical records for 244 children hospitalized with acute hematogenous MSKIs were manually reviewed to determine which bacterial pathogen, if any, was identified for each MSKI based on microbiology results obtained during the hospitalization. Microbiology results for each patient were then compared to their discharge diagnoses in the Pediatric Health Information System (PHIS) database to determine the accuracy of pathogen discharge codes. Discharge diagnostic codes correctly matched the microbiology results in 89.3% of encounters. Sensitivity and specificity for Staphylococcus aureus discharge diagnostic codes were 88.6% and 96.4% respectively for methicillin-susceptible S. aureus and 92.9% and 99.5% for methicillin-resistant S. aureus. Pathogen discharge codes are reliable surrogates that accurately reflect the microbiology results for children with MSKIs.