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Roby PR, McDonald CC, Corwin D, Grady MF, Master CL, Arbogast KB. Characteristics of Pediatric Concussion across Different Mechanisms of Injury in 5 through 12-Year-Olds. J Pediatr 2024:114157. [PMID: 38901776 DOI: 10.1016/j.jpeds.2024.114157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/10/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE To investigate characteristics of sport-related concussion (SRC), recreation-related concussion (RRC), and non-sport or recreation-related concussion (non-SRRC) in patients 5 through 12 years old, an understudied population in youth concussion. STUDY DESIGN This retrospective, observational study included patients aged 5 through 12 years presenting to a specialty care concussion setting at ≤28 days post-injury form 2018 through 2022. The following characteristics were assessed: demographics, injury mechanism (SRC, RRC, or SRRC), point of healthcare entry, and clinical signs and symptoms. Kruskal-Wallis and chi-square tests were used to assess group differences. Post hoc pairwise comparisons were employed for all analyses (α=0.017). RESULTS 1,141 patients reported at ≤28 days of injury (female=42.9%, median age=11, IQR=9-12) with the most common mechanism being RRC (37.3%), followed by non-SRRC (31.9%). More non-SRRCs (39.6%) and RRC (35.7%) were first seen in the emergency department (p<0.001) compared with SRC (27.9%). Patients with RRC and non-SRRC were first evaluated at specialists 4 and 6 days later than SRC (p<0.001). Patients with non-SRRC reported with higher symptom burden, more frequent visio-vestibular abnormalities, and more changes to sleep and daily habits (p<0.001) compared with RRC and SRC (p<0.001). CONCLUSIONS In concussion patients 5 through 12 years, RRCs and non-SRRC were more prevalent than SRC, presenting first more commonly to the emergency department and taking longer to present to specialists. Non-SRRC had more severe clinical features. RRC and non-SRRC are distinct from SRC in potential for less supervision at time of injury and less direct access to established concussion health care following injury.
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Affiliation(s)
- Patricia R Roby
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Catherine C McDonald
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Daniel Corwin
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Matthew F Grady
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Sports Medicine Performance Center, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Christina L Master
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Sports Medicine Performance Center, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA.
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Ochapa MO, McGrath LJ, Alfred T, Lopez SMC, Nepal RM. Increased disease severity during COVID-19 related hospitalization in black non-hispanic, hispanic and medicaid-insured young children. Front Pediatr 2024; 12:1373444. [PMID: 38933493 PMCID: PMC11203089 DOI: 10.3389/fped.2024.1373444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024] Open
Abstract
Background The COVID-19 pandemic has disproportionately affected marginalized groups in the United States. Although most children have mild or asymptomatic COVID-19, some experience severe disease and long-term complications. However, few studies have examined health disparities in severe COVID-19 outcomes among US children. Objective To examine disparities in the clinical outcomes of infants and children aged <5 years hospitalized with COVID-19 by race/ethnicity and payer status. Methods Children aged <5 years hospitalized with an admission diagnosis of COVID-19 (April 2021-February 2023) were selected from the PINC AI™ Healthcare Database. Hospital outcomes included length of stay (LOS), intensive care unit (ICU) admission, oxygen supplementation, invasive mechanical ventilation (IMV), and prolonged duration of each outcome. Multivariable logistic regression models compared hospitalization outcomes by race/ethnicity and payer status. Results Among 10,190 children (mean age: 0.9 years, 56.5% male, 66.7% Medicaid-insured), race/ethnicity was distributed as follows: White non-Hispanic (35.1%), Hispanic (any or Unknown race; 28.3%), Black non-Hispanic (15.2%), Other race/ethnicity (8.9%) and Unknown (12.5%). Payer status varied by race/ethnicity. White non-Hispanic children had the highest proportion with commercial insurance (42.9%) while other racial/ethnic groups ranged between 13.8% to 26.1%. Black non-Hispanic children had the highest proportion with Medicaid (82.3%) followed by Hispanic children (76.9%). Black non-Hispanic children had higher odds of prolonged outcomes: LOS (adjusted odds ratio [aOR] = 1.20, 95% confidence interval [CI]:1.05-1.38), ICU days (aOR = 1.44, 95% CI: 1.07-1.93), and IMV days (aOR = 1.80, 95% CI: 1.09-2.97) compared to White non-Hispanic children. Similar patterns were observed for Hispanic and children of Other race/ethnicity. Medicaid-insured and children with other insurance had higher odds of prolonged LOS and oxygen days than commercially insured patients. Conclusion There were disparities in clinical outcomes of COVID-19 by race/ethnicity and insurance type, particularly for prolonged-duration outcomes. Further research is required to fully comprehend the causes and consequences of these disparities and develop strategies to reduce them while ensuring equitable healthcare delivery.
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Affiliation(s)
- Monica Oyidu Ochapa
- Morgan State University School of Community Health and Policy, Baltimore, MD, United States
- US Scientific and Medical Affairs, Pfizer Inc., New York, NY, United States
| | - Leah J. McGrath
- Global Medical and Scientific Affairs, Pfizer Inc., New York, NY, United States
| | - Tamuno Alfred
- Statistical Research and Data Science Center, Pfizer Inc., New York, NY, United States
| | | | - Rajeev M. Nepal
- US Scientific and Medical Affairs, Pfizer Inc., New York, NY, United States
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Orr CJ, Leslie LK, Schaechter J, Williams XJ, Montez KG, Deen JF, Evans YN, Russell CJ, Webb J, Gaona AR, Mendoza FS. Diversity, Equity, and Inclusion, Child Health, and the Pediatric Subspecialty Workforce. Pediatrics 2024; 153:e2023063678S. [PMID: 38300010 PMCID: PMC10852199 DOI: 10.1542/peds.2023-063678s] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Using multiple metrics, the diversity of the pediatric population in the United States is increasing. However, recent data suggest significant disparities in both the prevalence and management of child health conditions cared for by pediatric subspecialists. These inequities occur across multiple dimensions of diversity, including race and ethnicity, country of origin, socioeconomic status, sex and gender, and disability. Research also suggests that attending to diversity, equity, and inclusion in the medical workforce may positively affect health outcomes. High-quality pediatric subspecialty care thus requires knowledge of these data, attention to the effects of social drivers, including racism and discrimination, on health and wellbeing, and interventions to improve pediatric health equity through educational, practice, policy, and research innovations. In this article, we review data on the diversity of the pediatric population and pediatric subspecialty workforce, suggest potential strengths, weaknesses, opportunities, and threats of current diversity, equity, and inclusion initiatives in academic pediatrics, and provide recommendations across 4 domains: education and training, practice, policy, and future research. The ultimate goal of pediatrics is to improve health equity for all infants, children, adolescents, and young adults cared for in the United States by pediatric subspecialists.
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Affiliation(s)
- Colin J. Orr
- Department of Pediatrics
- Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Kimberly G. Montez
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Jason F. Deen
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Yolanda N. Evans
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | | | - Jonathan Webb
- American Board of Pediatrics, Chapel Hill, North Carolina
- Association of Women’s Health Obstetric and Neonatal Nurses, Washington, District of Columbia
| | | | - Fernando S. Mendoza
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, California
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Soprano CM, Ngo R, Konys CA, Bazier A, Salamon KS. Post-Acute Sequelae of COVID-19 (PASC) in Pediatrics: Factors That Impact Symptom Severity and Referral to Treatment. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1805. [PMID: 38002896 PMCID: PMC10670189 DOI: 10.3390/children10111805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023]
Abstract
The post-acute sequelae of COVID-19 (PASC) is a complex condition. While there are emerging studies on its effects in adults, there is scarce research regarding the long-term effects of COVID-19 infection among youth. Several researchers have likened long-haul COVID-19 to chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and postural orthostatic tachycardia syndrome (POTS). In adults, the prognosis for these diagnoses is less promising than that in youth; however, there is currently very little information available on the presentation of youth with PASC. A better understanding of the specific symptom presentation for youth diagnosed with PASC is necessary. Retrospective chart reviews were conducted collecting demographic data, COVID-19 symptoms and disease progression, and vaccination status. Additional data on referrals to a PASC treatment program and appointments attended were collected. Overall, data suggested that youth present with less severe PASC symptoms than adults, and the role of vaccination is unclear. These youth are often not referred to treatment programs. More exploration is necessary to continue to build an understanding of how best to aid youth diagnosed with PASC.
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Affiliation(s)
- Catherine M. Soprano
- Nemours Children’s Health, Wilmington, DE 19803, USA;
- Sydney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ryan Ngo
- Bowdoin College, Brunswick, ME 04011, USA
| | - Casey A. Konys
- Lurie Children’s Hospital of Chicago, Chicago, IL 60614, USA
| | - Ashley Bazier
- School of Medicine, Indiana University, Indianapolis, IN 46805, USA
| | - Katherine S. Salamon
- Nemours Children’s Health, Wilmington, DE 19803, USA;
- Sydney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Flores AR, Tan TQ, Bryant KA. Creating a Diverse and Inclusive Pediatric Infectious Diseases Workforce. J Pediatric Infect Dis Soc 2022; 11:S125-S126. [PMID: 36099364 PMCID: PMC9494389 DOI: 10.1093/jpids/piac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Anthony R Flores
- To whom correspondence should be addressed: Anthony R. Flores, MD, MPH, PhD, UTHealth Houston, 6431 Fannin St, MSB 3.130, Houston, TX 77030;
| | - Tina Q Tan
- Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Kristina A Bryant
- Alternate corresponding author: Kristina A. Bryant, MD, University of Louisville Pediatric Infectious Diseases, 571 South Floyd Street, Suite 321, Louisville, KY 40202;
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