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Reisner A, Burns TG, Hall LB, Jain S, Weselman BC, De Grauw TJ, Ono KE, Blackwell LS, Chern JJ. Quality Improvement in Concussion Care: Influence of Guideline-Based Education. J Pediatr 2017; 184:26-31. [PMID: 28233546 DOI: 10.1016/j.jpeds.2017.01.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/16/2016] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the potential impact of a concussion management education program on community-practicing pediatricians. STUDY DESIGN We prospectively surveyed 210 pediatricians before and 18 months after participation in an evidence-based, concussion education program. Pediatricians were part of a network of 38 clinically integrated practices in metro-Atlanta. Participation was mandatory for at least 1 pediatrician in each practice. We assessed pediatricians' self-reported concussion knowledge, use of guidelines, and comfort level, as well as self-reported referral patterns for computed tomography (CT) and/or emergency department (ED) evaluation of children who sustained concussion. RESULTS Based on responses from 120 pediatricians participating in the 2 surveys and intervention (response rate, 57.1%), the program had significant positive effects from pre- to postintervention on knowledge of concussions (-0.26 to 0.56 on -3 to +1 scale; P < .001), guideline use (0.73-.06 on 0-6 scale; P < .01), and comfort level in managing concussions (3.76-4.16 on 1-5 scale; P < .01). Posteducation, pediatricians were significantly less likely to self-report referral for CT (1.64-1.07; P < .001) and CT/ED (4.73-3.97; P < .01), but not ED referral alone (3.07-3.09; P = ns). CONCLUSIONS Adoption of a multifaceted, evidence-based, education program translated into a positive modification of self-reported practice behavior for youth concussion case management. Given the surging demand for community-based youth concussion care, this program can serve as a model for improving the quality of pediatric concussion management.
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Affiliation(s)
- Andrew Reisner
- Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, GA; Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA.
| | - Thomas G Burns
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Larry B Hall
- Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, GA
| | - Shabnam Jain
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA
| | | | - Ton J De Grauw
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA
| | - Kim E Ono
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Laura S Blackwell
- Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Joshua J Chern
- Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, GA
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Reisner A, Popoli DM, Burns TG, Marshall DL, Jain S, Hall LB, Vova JA, Kroll S, Weselman BC, Palasis S, Hayes LL, Clark GH, Speake KM, Holbrook BH, Wiskind RH, Licata RM, Ono KE, Hogan E, Chern JJ, DeGrauw T. The Central Role of Community-Practicing Pediatricians in Contemporary Concussion Care: A Case Study of Children's Healthcare of Atlanta's Concussion Program. Clin Pediatr (Phila) 2015; 54:1031-7. [PMID: 25715824 DOI: 10.1177/0009922815573468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Andrew Reisner
- Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University, Atlanta, GA, USA
| | | | - Thomas G Burns
- Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University, Atlanta, GA, USA
| | | | - Shabnam Jain
- Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University, Atlanta, GA, USA
| | - Larry B Hall
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Steve Kroll
- Children's Orthopaedics of Atlanta, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | - Kim E Ono
- Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University, Atlanta, GA, USA
| | | | - Joshua J Chern
- Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University, Atlanta, GA, USA
| | - Ton DeGrauw
- Children's Healthcare of Atlanta, Atlanta, GA, USA Emory University, Atlanta, GA, USA
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Drossner D, Oster M, Phelps H, Weselman BC, Frias P. PEDIATRIC CARDIOLOGY EVALUATION OF CHEST PAIN – ARE WE MEETING PEDIATRICIANS' EXPECTATIONS? J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Weselman BC, Friedman DB, Warren RW, Soriano HE. Risks of endoscopy in hospitalized pediatric patients with collagen vascular diseases. Gastrointest Endosc 1999; 49:622-5. [PMID: 10228261 DOI: 10.1016/s0016-5107(99)70391-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The gastrointestinal manifestations of the collagen vascular diseases have been well described in the pediatric population. These patients frequently have symptoms that constitute indications for endoscopy. However, the risks and benefits of endoscopy in this population have not been examined. METHODS A retrospective review of all patients with collagen vascular diseases hospitalized during a 7-year period was undertaken, and those patients who underwent endoscopy were identified. RESULTS Nine patients (5%) underwent endoscopic procedures (eight upper and three lower endoscopy). Complications and outcomes were analyzed. Indications for endoscopy included abdominal pain, gastrointestinal (GI) bleeding, and/or vomiting and diarrhea. Two patients had complications that required surgery within 1 day of the endoscopic procedure. One of these patients subsequently died with GI bleeding. Five of the nine patients had changes in their management after endoscopy. Helicobacter pylori infection was identified and treated in two patients. Three patients had esophagitis or gastritis and acid suppression treatment was started or optimized. Vasculopathy was present in the patients who had complications. CONCLUSIONS This series suggests that endoscopy can provide useful information for the management of the pediatric patient with GI symptoms and collagen vascular diseases. However, because serious and potentially life-threatening complications can occur, great care is needed in evaluating the risk/benefit ratio of endoscopy in these patients.
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Affiliation(s)
- B C Weselman
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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