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Hoffmann JA, Krass P, Rodean J, Bardach NS, Cafferty R, Coker TR, Cutler GJ, Hall M, Morse RB, Nash KA, Parikh K, Zima BT. Follow-up After Pediatric Mental Health Emergency Visits. Pediatrics 2023; 151:e2022057383. [PMID: 36775807 PMCID: PMC10187982 DOI: 10.1542/peds.2022-057383] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Accepted: 07/27/2022] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVES To examine how outpatient mental health (MH) follow-up after a pediatric MH emergency department (ED) discharge varies by patient characteristics and to evaluate the association between timely follow-up and return encounters. METHODS We conducted a retrospective study of 28 551 children aged 6 to 17 years with MH ED discharges from January 2018 to June 2019, using the IBM Watson MarketScan Medicaid database. Odds of nonemergent outpatient follow-up, adjusted for sociodemographic and clinical characteristics, were estimated using logistic regression. Cox proportional hazard models were used to evaluate the association between timely follow-up and risk of return MH acute care encounters (ED visits and hospitalizations). RESULTS Following MH ED discharge, 31.2% and 55.8% of children had an outpatient MH visit within 7 and 30 days, respectively. The return rate was 26.5% within 6 months. Compared with children with no past-year outpatient MH visits, those with ≥14 past-year MH visits had 9.53 odds of accessing follow-up care within 30 days (95% confidence interval [CI], 8.75-10.38). Timely follow-up within 30 days was associated with a 26% decreased risk of return within 5 days of the index ED discharge (hazard ratio, 0.74; 95% CI, 0.63-0.91), followed by an increased risk of return thereafter. CONCLUSIONS Connection to outpatient care within 7 and 30 days of a MH ED discharge remains poor, and children without prior MH outpatient care are at highest risk for poor access to care. Interventions to link to outpatient MH care should prioritize follow-up within 5 days of an MH ED discharge.
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Affiliation(s)
- Jennifer A. Hoffmann
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Polina Krass
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA
| | | | - Naomi S. Bardach
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco
| | - Rachel Cafferty
- Division of Emergency Medicine, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Tumaini R. Coker
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Research Institute, Seattle, Washington
| | - Gretchen J. Cutler
- Children’s Minnesota Research Institute, Children’s Minnesota, Minneapolis, MN
| | | | - Rustin B. Morse
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
- Nationwide Children’s Hospital, Center for Clinical Excellence, Columbus, Ohio
| | - Katherine A. Nash
- Department of Pediatrics, New York Presbyterian Morgan Stanley Childrens Hospital, Columbia University, New York City, New York
| | - Kavita Parikh
- Division of Hospital Medicine, Children’s National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Bonnie T. Zima
- Center for Health Services and Society, UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
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Bowden CF, Worsley D, Esposito JM, Cutler GJ, Doupnik SK. Pediatric emergency departments' readiness for change toward improving suicide prevention: A mixed-methods study with US leaders. J Am Coll Emerg Physicians Open 2022; 3:e12839. [PMID: 36311338 PMCID: PMC9597096 DOI: 10.1002/emp2.12839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 09/14/2022] [Accepted: 09/29/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To assess pediatric emergency departments' (PEDs) current suicide prevention practices and climate for change to improve suicide prevention for youth. Methods We conducted an explanatory, sequential mixed-methods study. First, we deployed a national, cross-sectional survey of PED leaders identified through publicly available data in Fall 2020, and then we conducted follow-up interviews with those who expressed interest. The survey queried each PED's suicide prevention practices and measured readiness for change to improve suicide prevention practices using questions scored on a 5-point Likert scale. Interviews gathered further, in-depth descriptions of PEDs' practices and culture. Interviews were audio-recorded, transcribed verbatim, and analyzed using a rapid analysis approach. Results Of 135 PED directors eligible to complete the survey, 64 responded (response rate 47%). A total of 64% of PEDs had a mental health specialist available 24 hours/day, 7 days/week; 80% reported practicing mental health disposition planning, and 41% reported practicing psychiatric medication management. Altogether 91% of directors agreed or strongly agreed that their PED had a positive culture and 92% agreed/strongly agreed that their PED was ready for change. However, 31% disagreed/strongly disagreed that their PED had tools for evaluation and quality measurement. Resources needed for change (including budget, staffing, training, and facilities) varied across institutions. Interviews with our convenience sample of 21 directors revealed varying suicide prevention practices and confirmed that standardization, evaluation, and quality improvement initiatives were needed at most institutions. Leaders reported a high interest in improving care. Conclusions PED leaders reported high motivation to improve suicide prevention services for young people, and reported needing quality improvement infrastructure to monitor and guide improvement.
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Affiliation(s)
- Cadence F. Bowden
- Division of General PediatricsClinical Futures, and PolicyLabChildren'sHospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Diana Worsley
- Division of General PediatricsClinical Futures, and PolicyLabChildren'sHospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Jeremy M. Esposito
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Division of Emergency MedicineChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Gretchen J. Cutler
- Children's Minnesota Research InstituteChildren's MinnesotaMinneapolisMinnesotaUSA
| | - Stephanie K. Doupnik
- Division of General PediatricsClinical Futures, and PolicyLabChildren'sHospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Cutler GJ, Bergmann KR, Doupnik SK, Hoffmann JA, Neuman MI, Rodean J, Zagel AL, Zima BT. Pediatric Mental Health Emergency Department Visits and Access to Inpatient Care: A Crisis Worsened by the COVID-19 Pandemic. Acad Pediatr 2022; 22:889-891. [PMID: 35351651 PMCID: PMC8957359 DOI: 10.1016/j.acap.2022.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Gretchen J Cutler
- Children's Minnesota Research Institute, Children's Minnesota (GJ Cutler), Minneapolis, Minn.
| | - Kelly R Bergmann
- Department of Pediatric Emergency Medicine, Children's Minnesota (KR Bergmann), Minneapolis, Minn
| | - Stephanie K Doupnik
- Division of General Pediatrics, PolicyLab, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia (SK Doupnik), Philadelphia, Pa
| | - Jennifer A Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago (JA Hoffmann), Chicago, Ill
| | - Mark I Neuman
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School (MI Neuman), Boston, Mass
| | | | - Alicia L Zagel
- Fairview Pharmacy Services (AL Zagel), Minneapolis, Minn
| | - Bonnie T Zima
- UCLA Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles (BT Zima), Los Angeles, Calif
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Leuche VT, Cutler GJ, Nelson SC, Jin J, Bergmann KR. Emergency Department Health Care Utilization and Opioid Administration Among Pediatric Patients With Sickle Cell Vasoocclusive Pain Crisis and Coexisting Mental Health Illness. Pediatr Emerg Care 2022; 38:e664-e669. [PMID: 33969978 DOI: 10.1097/pec.0000000000002322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether patients with sickle cell disease (SCD) who present to the emergency department (ED) with vasoocclusive pain crises (VOC), and have coexisting mental health (MH) diagnoses, are more likely to have increased health care utilization and more frequent opioid administration compared with those without coexisting MH conditions. METHODS This is a retrospective study of patients aged 5 to 18 years with SCD who presented to a tertiary care ED with a primary complaint of VOC between January 1, 2013, and December 31, 2017. We excluded patients with sickle cell trait and without a pain management plan in the electronic medical record. Outcomes included ED length of stay (LOS), admission rate, and opioid administration in the ED. Morphine equivalents were used to standardize opioid dosing. Mann-Whitney U and χ2 tests were used for univariate analysis. Multivariable logistic was performed for categorical and continuous outcomes, respectively, after adjusting for confounding factors. RESULTS We identified 978 encounters. We excluded 196 without a pain management plan and one with inaccurate ED LOS, resulting in 781 encounters (148 patients) for analysis. Coexisting MH diagnoses were present in 75.0% of encounters, with anxiety (83.0%) and depressive disorders (55.9%) being most common. Compared with SCD patients without coexisting MH diagnoses, those with coexisting MH diagnoses had significantly longer ED LOS (252 ± 139 minutes vs 232 ± 145 minutes, P = 0.03), longer median hospital LOS (1.4 ± 3.2 days vs 0.3 ± 2.4 days, P < 0.001) in univariate analyses, but these differences were no longer significant in adjusted regression models. Patients with coexisting MH diagnoses had higher frequency of opioid administration in the ED (85.6% vs 71.4%, P < 0.0001) and higher odds of receiving opioids (adjusted odds ratio, 2.07; 95% confidence interval, 1.28-3.33). CONCLUSIONS Patients with SCD and coexisting MH diagnoses presenting with VOC have greater odds of receiving opioids compared with patients with SCD without coexisting MH diagnoses. Our results indicate a need for more MH resources in this vulnerable population and may help guide future management strategies.
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Affiliation(s)
| | | | - Stephen C Nelson
- Department of Hematology and Oncology, Children's Minnesota, Minneapolis, MN
| | - Jing Jin
- Children's Minnesota Research Institute
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5
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Abstract
OBJECTIVES This study aimed to characterize pediatric visits to emergency departments (EDs) for firearm injuries and examine differences by trauma center type. METHODS Analyses included all patients younger than 19 years from the National Trauma Data Bank, years 2009 to 2014. Trauma centers were categorized as adult, mixed adult and pediatric, or pediatric based on certification level. Baseline characteristics were compared between subgroups using χ2 tests. Multivariable logistic regression was used to examine risk of death. RESULTS Of 466,403 pediatric ED visits, 21,416 (4.6%) resulted from a firearm injury. Most firearm injuries were treated at an adult (64.9%) or mixed trauma center (29.1%) and involved patients that were male (87.1%), in the 15- to 18-year age group (83.2%), and black or African American (61.3%). Most visits were for injuries resulting from assault (78.1%), followed by unintentional (12.6%) and self-inflicted (4.7%) injuries, undetermined intent (3.7%), and legal intervention (0.8%). Patients visiting EDs for firearm injuries had more than 7 times the odds of dying compared with patients with other injuries (odds ratio, 7.30; 95% confidence interval, 6.82-7.72), and firearm injuries were responsible for more than a quarter (26.1%) of the total pediatric deaths in the National Trauma Data Bank (n = 2866). Assault-related injuries resulted in the most deaths (n = 2010; 70.1%), but the case fatality rate was highest for self-inflicted (n = 453; 44.6%). CONCLUSION We identified more than 20,000 firearm-related ED visits by pediatric patients from 2009 to 2014, averaging nearly 10 visits per day. Findings from this study can inform strategic planning in hospitals focused on preventing firearm injuries in children and adolescents.
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Affiliation(s)
| | | | | | | | - Anupam B Kharbanda
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
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6
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Spaulding AB, Zagel AL, Cutler GJ, Brown A, Zier JL. Organ Donation Authorization After Brain Death Among Patients Admitted to PICUs in the United States, 2009-2018. Pediatr Crit Care Med 2021; 22:303-311. [PMID: 33332867 DOI: 10.1097/pcc.0000000000002648] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To identify trends in and factors associated with pediatric organ donation authorization after brain death. DESIGN Retrospective cohort study of data from Virtual Pediatric Systems, LLC (Los Angeles, CA). SETTING Data from 123 PICUs reporting to Virtual Pediatric Systems from 2009 to 2018. PATIENTS Patients less than 19 years old eligible for organ donation after brain death. MEASUREMENTS AND MAIN RESULTS Of 2,777 eligible patients, 1,935 (70%) were authorized for organ donation; the authorization rate remained unchanged over time (ptrend = 0.22). In a multivariable logistic regression model, hospitalizations lasting greater than 7 days had lower odds of authorization (adjusted odds ratio, 0.5; p < 0.001 vs ≤ 1 d) and White patients had higher odds than other race/ethnicity groups. Authorization was higher for trauma-related encounters (adjusted odds ratio, 1.5; p < 0.001) and when donation was discussed with an organ procurement organization coordinator (adjusted odds ratio, 1.7; p < 0.001). Of 123 hospitals, 35 (28%) met or exceeded a 75% organ donation authorization target threshold; these hospitals more often had an organ procurement organization coordinator discussing organ donation (85% vs 72% of encounters; p < 0.001), but no difference was observed by PICU bed size. CONCLUSIONS Organ donation authorization after brain death among PICU patients was associated with length of stay, race/ethnicity, and trauma-related encounter, and authorization rates were higher when an organ procurement organization coordinator was involved in the donation discussion. This study identified factors that could inform initiatives to improve the authorization process and increase pediatric organ donation rates.
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Affiliation(s)
| | - Alicia L Zagel
- Children's Minnesota Research Institute, Minneapolis, MN
| | | | - Angela Brown
- Critical Care Department, Children's Minnesota, Minneapolis, MN
| | - Judith L Zier
- Critical Care Department, Children's Minnesota, Minneapolis, MN
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7
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Russell H, Hall M, Morse RB, Cutler GJ, Macy M, Bettenhausen JL, Lopez MA, Shah SS, Sills MR. Longitudinal Trends in Costs for Hospitalizations at Children's Hospitals. Hosp Pediatr 2020; 10:797-801. [PMID: 32747333 DOI: 10.1542/hpeds.2020-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Children's hospitals are increasingly focused on value-based improvement efforts to improve outcomes and lower costs. Such efforts are generally focused on improving outcomes in specific conditions. Examination of cost drivers across all admissions may facilitate strategic prioritization of efforts. METHODS Pediatric Health Information System data set discharges from 2010 to 2017 were aggregated into services lines and billing categories. The mean annual growth per discharge as a percentage of 2010 total costs was calculated for aggregated medical and surgical service lines and 6 individual service lines with highest rates of growth. The mean annual growth per discharge for each billing category and changes in length of stay was further assessed. RESULTS The mean annual growth in total costs was similar for aggregated medical (2.6%) and surgical (2.7%) service lines. Individual medical service lines with highest mean annual growth were oncology (3.5%), reproductive services (2.9%), and nonsurgical orthopedics (2.8%); surgical service lines with highest rate of growth were solid organ transplant (3.7%), ophthalmology (3.3%), and otolaryngology (2.9%). CONCLUSIONS Room costs contributed most consistently to cost increases without concomitant increases in length of stay. Value-based health care initiatives must focus on room cost increases and their impacts on patient outcomes.
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Affiliation(s)
- Heidi Russell
- Department of Pediatrics and .,Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Rustin B Morse
- Children's Health, Children's Medical Center, Dallas, Texas.,Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - Gretchen J Cutler
- Children's Minnesota Research Institute, Children's Minnesota, Minneapolis, Minnesota
| | - Michelle Macy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | | | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
| | - Marion R Sills
- Department of Pediatrics, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
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8
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Lopez MA, Hall M, Auger KA, Bettenhausen JL, Colvin JD, Cutler GJ, Fieldston E, Macy ML, Morse R, Raphael JL, Russell H, Shah SS, Sills MR. Care of Pediatric High-Cost Hospitalizations Across Hospital Types. Hosp Pediatr 2020; 10:206-213. [PMID: 32024665 DOI: 10.1542/hpeds.2019-0258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND High-cost hospitalizations (HCHs) account for a substantial proportion of pediatric health care expenditures. We aimed to (1) describe the distribution of pediatric HCHs across hospital types caring for children and (2) compare characteristics of pediatric HCHs by hospital type. METHODS Cross-sectional analysis of all pediatric hospitalizations in the 2012 Kids' Inpatient Database. HCHs were defined as costs >$40 000 (94th percentile). Hospitals were categorized as children's, small general, and large general. RESULTS Approximately 166 000 HCHs were responsible for 50.8% of aggregate hospital costs ($18.1 of $35.7 billion) and were mostly at children's hospitals (65%). Children with an HCH were largely neonates (45%), had public insurance (50%), and had ≥1 chronic condition (74%). A total of 131 children's hospitals cared for a median of 559 HCHs per hospital (interquartile range [IQR]: 355-1153) compared to 76 HCHs per hospital (IQR: 32-151) at 397 large general hospitals and 5 HCHs per hospital (IQR: 2-22) at 3581 small general hospitals. The median annual aggregate cost for HCHs was $60 million (IQR: $36-$135) per children's hospital compared to $6.6 million (IQR: $2-$15) per large general hospital and $300 000 (IQR: $116 000-$1.5 million) per small general hospital. HCHs from children's hospitals encompassed nearly 5 times as many unique clinical conditions as large general hospitals and >30 times as many as small general hospitals. CONCLUSIONS Children's hospitals cared for a disproportionate volume, cost, and diversity of HCHs compared to general hospitals. Future studies should characterize the factors driving cost, resources, and reimbursement practices for HCH to ensure the long-term financial viability of the pediatric health care system.
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Affiliation(s)
- Michelle A Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas;
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Katherine A Auger
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | - Evan Fieldston
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle L Macy
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Rustin Morse
- Children's Health System of Texas, Dallas, Texas; and
| | - Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Heidi Russell
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Center for Medical Ethics and Health Policy and
| | - Samir S Shah
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marion R Sills
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
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Cutler GJ, Rodean J, Zima BT, Doupnik SK, Zagel AL, Bergmann KR, Hoffmann JA, Neuman MI. Trends in Pediatric Emergency Department Visits for Mental Health Conditions and Disposition by Presence of a Psychiatric Unit. Acad Pediatr 2019; 19:948-955. [PMID: 31175994 PMCID: PMC7122010 DOI: 10.1016/j.acap.2019.05.132] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/11/2019] [Accepted: 05/31/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine trends in mental health (MH) visits to pediatric emergency departments (EDs) and identify whether ED disposition varies by presence of a hospital inpatient psychiatric unit (IPU). STUDY DESIGN Cross-sectional study of 8,479,311 ED visits to 35 children's hospitals from 2012 to 2016 for patients aged 3 to 21 years with a primary MH or non-MH diagnosis. Multivariable generalized estimating equations and bivariate Rao-Scott chi-square tests were used to examine trends in ED visits and ED disposition by IPU status, adjusted for clustering by hospital. RESULTS From 2012 to 2016, hospitals experienced a greater increase in ED visits with a primary MH versus non-MH diagnosis (50.7% vs 12.7% cumulative increase, P < .001). MH visits were associated with patients who were older, female, white non-Hispanic, and privately insured compared with patients of non-MH visits (all P < .001). Forty-four percent of MH visits in 2016 had a primary diagnosis of depressive disorders or suicide or self-injury, and the increase in visits was highest for these diagnosis groups (depression: 109.8%; suicide or self-injury: 110.2%). Among MH visits, presence of a hospital IPU was associated with increased hospitalizations (34.6% vs 22.5%, P < .001) and less transfers (9.2% vs 16.2%, P < .001). CONCLUSION The increase in ED MH visits from 2012 to 2016 was 4 times greater than non-MH visits at US children's hospitals and was primarily driven by patients diagnosed with depressive disorders and suicide or self-injury. Our findings have implications for strategic planning in tertiary children's hospitals dealing with a rising demand for acute MH care.
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Affiliation(s)
- Gretchen J Cutler
- Children's Minnesota Research Institute (CJ Cutler, AL Zagel), Children's Minnesota, Minneapolis, Minn.
| | | | - Bonnie T Zima
- UCLA Semel Institute for Neuroscience and Human Behavior (B Zima), University of California at Los Angeles, Los Angeles, Calif
| | - Stephanie K Doupnik
- Division of General Pediatrics (SK Doupnik), PolicyLab, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Alicia L Zagel
- Children's Minnesota Research Institute (CJ Cutler, AL Zagel), Children's Minnesota, Minneapolis, Minn
| | - Kelly R Bergmann
- Department of Pediatric Emergency Medicine (KR Bergman), Children's Minnesota, South, Minneapolis, Minn
| | - Jennifer A Hoffmann
- Division of Emergency Medicine (JA Hoffmann, MI Neuman), Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Mark I Neuman
- Division of Emergency Medicine (JA Hoffmann, MI Neuman), Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Mass
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10
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Zagel AL, Cutler GJ, Linabery AM, Spaulding AB, Kharbanda AB. Unintentional Injuries in Primary and Secondary Schools in the United States, 2001-2013. J Sch Health 2019; 89:38-47. [PMID: 30506700 DOI: 10.1111/josh.12711] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/18/2018] [Accepted: 05/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Unintentional injuries are the leading cause of youth morbidity. However, limited nationally representative data are available to characterize the occurrence of unintentional injuries at US schools. Given this paucity, we characterized secular trends in unintentional injuries at schools that led to emergency department (ED) visits. METHODS A retrospective analysis of the National Electronic Injury Surveillance System-All Injury Program from 2001 to 2013 compared injuries occurring at schools to injuries occurring elsewhere in youth ages 5-18 years. Incidence rates were calculated using weighted frequency estimates as numerators and US population estimates as denominators. RESULTS School injuries accounted for 21% of unintentional injury-related ED visits, with an estimated annual incidence rate of 1385 injuries per 100,000 5- to 18-year-olds. Middle school-aged youth (10-13 years) had the highest annual incidence rate (1640 per 100,000 youth) compared with younger and older counterparts. School injuries were more likely to be due to sports/recreation than nonschool injuries (55% vs 41%, p < .0001). Importantly, no detectable change in incidence rates of school injuries between 2001 and 2013 was found (p = .11). CONCLUSIONS Stagnant annual incidence rates of unintentional injuries at schools and large numbers of school-based injuries demonstrate that school-based injuries are a notable opportunity for future prevention efforts.
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Affiliation(s)
- Alicia L Zagel
- Children's Minnesota Research Institute, 2525 Chicago Avenue South, MS 40-460, Minneapolis, MN
| | - Gretchen J Cutler
- Children's Minnesota Research Institute, 2525 Chicago Avenue South, MS 40-460, Minneapolis, MN
| | - Amy M Linabery
- Children's Minnesota Research Institute, 2525 Chicago Avenue South, MS 40-460, Minneapolis, MN
| | - Alicen B Spaulding
- Children's Minnesota Research Institute, 2525 Chicago Avenue South, MS 40-460, Minneapolis, MN
| | - Anupam B Kharbanda
- Children's Minnesota Research Institute, Department of Pediatric Emergency Medicine, Children's Minnesota, 2525 Chicago Avenue South, MS 40-460, Minneapolis, MN
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11
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Ronning MM, Carolan PL, Cutler GJ, Patterson RJ. Parasagittal vertex clots on head CT in infants with subdural hemorrhage as a predictor for abusive head trauma. Pediatr Radiol 2018; 48:1915-1923. [PMID: 30187091 DOI: 10.1007/s00247-018-4237-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 02/24/2018] [Revised: 07/17/2018] [Accepted: 08/10/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Abusive head trauma (AHT) is the most common cause of subdural hemorrhage (SDH) in infants younger than 12 months old. Clot formation in the parasagittal vertex seen on imaging has been associated with SDH due to AHT. There have been very few studies regarding these findings; to our knowledge, no studies including controls have been performed. OBJECTIVE To describe parasagittal vertex clots on head computed tomography (CT) in infants with SDH and AHT compared to patients with SDH and accidental trauma, and to evaluate for parasagittal vertex clots in the absence of SDH in the setting of known accidental head trauma. MATERIALS AND METHODS All infants younger than 12 months old with SDH present on CT scan were retrospectively identified from 2004 to 2014. Blinded, independent review of all CT scans for clot formation at the parasagittal vertex was performed by a pediatric neuroradiologist. RESULTS Ninety-nine patients were eligible for analysis. Mean age was 4 months. Fifty-seven (57.6%) were male. Fifty-five (55.6%) patients were identified as having AHT and 22 (22.2%) had accidental trauma. Forty-five (81.2%) patients with AHT had parasagittal vertex clots present on CT scan compared to 8 (36.4%) patients with accidental trauma. Compared to patients without parasagittal vertex clots, those with parasagittal vertex clots were more likely to have AHT (66.2% vs. 32.3%, P=0.001), no known mechanism of injury (69.1% vs. 32.3%, P=0.015), retinal hemorrhage (75% vs. 35.5%, P=0.002) and hypoxic-ischemic changes (25% vs. 0%, P=0.002). Patients with parasagittal vertex clots have eight times the odds of AHT compared to patients without parasagittal vertex clots. Age-matched control patients who underwent head CT scan due to a history of accidental head injury without SDH were identified (n=87); no patient in the control group had parasagittal vertex clots. CONCLUSION The finding of parasagittal vertex clots on CT scans should raise suspicion for abuse and prompt further investigation, especially in the setting of no known, uncertain or inconsistent mechanism of injury.
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Affiliation(s)
- Meghann M Ronning
- Department of Emergency Medicine, Children's Hospital and Clinics of Minnesota, 2525 Chicago Ave., Minneapolis, MN, 55404, USA.
| | - Patrick L Carolan
- Department of Emergency Medicine, Children's Hospital and Clinics of Minnesota, 2525 Chicago Ave., Minneapolis, MN, 55404, USA
| | - Gretchen J Cutler
- Center for Acute Care Outcomes, Children's Hospital and Clinics of Minnesota, Minneapolis, MN, USA
| | - Richard J Patterson
- Department of Radiology, Children's Hospital and Clinics of Minnesota, Minneapolis, MN, USA
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12
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Abstract
OBJECTIVE To describe the relationship between injury region and risk of hospital-acquired pneumonia (HAP) in pediatric trauma patients. METHODS Analyses included patients <19 years of age from the National Trauma Data Bank, during 2009-2011. Multivariable logistic regression was used to examine the association between injury region and odds of developing HAP stratified by age group. RESULTS A total of 71 377 patients were eligible for analysis, and 1818 patients developed pneumonia. In adjusted regression models both younger (11-15 years) and older (16-18 years) adolescents with multisite injuries including the head and neck had higher odds of developing HAP compared with adolescents with isolated head and neck injuries (odds ratio [OR] = 2.04, 95% confidence interval [CI] 1.34-3.10; OR = 1.47, 95% CI 1.14-1.89, respectively), and younger adolescents with multisite injuries not involving the head and neck also had higher odds of developing HAP (OR = 1.97, 95% CI 1.08-3.60). We found no significant association between injury region and risk of HAP in children <11 years of age. Younger and older adolescents with firearm (OR = 1.85, 95% CI 1.00-3.42; OR = 1.39, 95% CI 1.02-1.88, respectively) or pulmonary (OR = 3.78, 95% CI 1.26-11.3; OR = 2.56, 95% CI 1.01-6.51, respectively) injuries had higher odds of developing HAP compared with those with motor vehicle collision injuries. CONCLUSIONS Adolescent trauma patients with multisite injuries including the head and neck have a higher risk of developing HAP compared with those with isolated head and neck injuries. We identified several risk factors that can be used to inform future research focused on identifying subgroups at high risk for the development of HAP.
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Affiliation(s)
| | | | - Jeffrey Nowak
- Division of Critical Care Medicine, Children's Minnesota, Minneapolis, Minnesota
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Hu T, Jacobs DR, Larson NI, Cutler GJ, Laska MN, Neumark-Sztainer D. Higher Diet Quality in Adolescence and Dietary Improvements Are Related to Less Weight Gain During the Transition From Adolescence to Adulthood. J Pediatr 2016; 178:188-193.e3. [PMID: 27640354 PMCID: PMC5085861 DOI: 10.1016/j.jpeds.2016.08.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/19/2016] [Accepted: 08/08/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the previously validated A Priori Diet Quality Score (APDQS), and weight change among adolescents transitioning into young adulthood. STUDY DESIGN Young people were recruited in middle/high schools and followed for 10 years. Participants reported diet and weight in 1999 (mean age, 15 years), 2004 (20 years), and 2009 (25 years). The analytic sample (n = 2656) had dietary intake assessments in 1999 and at least one other assessment. The APDQS (without alcoholic items) was based on 13 beneficial food groups, 12 adverse food groups, and 9 neutral food groups to capture aspects of Mediterranean/prudent diets, focusing on foods that are varied, based on nutritionally rich plants, and less processed. RESULTS From mean age 15 to 25 years, mean (SD) weight increased from 61.0 (14.7) kg to 76.1 (18.8) kg, and APDQS increased from 43.1 (11.1) points to 45.6 (10.7) points. Within-person tracking correlation of the APDQS was 0.35 at mean age 15-20 years, increasing to 0.49 at 20-25 years. Independent of lifestyle factors and energy intake, a 15-point (IQR) higher APDQS in 1999 was associated with 1.5 kg (95% CI, 0.7-2.3 kg) less weight gain over 10 years, The increase in APDQS over time was similarly associated with less concurrent weight gain. Findings were stronger for models of excess weight gain. CONCLUSION Higher diet quality, based on an assessment of dietary patterns in and after adolescence, was associated with reduced weight gain during the next 10 years. Establishment of high-quality dietary patterns in adolescence may help mitigate excess weight gain by young adulthood.
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Affiliation(s)
- Tian Hu
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
| | - Nicole I Larson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Gretchen J Cutler
- Department of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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Bergmann KR, Milner DM, Voulgaropoulos C, Cutler GJ, Kharbanda AB. Optic Nerve Sheath Diameter Measurement During Diabetic Ketoacidosis: A Pilot Study. West J Emerg Med 2016; 17:531-41. [PMID: 27625716 PMCID: PMC5017836 DOI: 10.5811/westjem.2016.6.29939] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/26/2016] [Accepted: 06/13/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kelly R Bergmann
- Children's Hospitals and Clinics of Minnesota, Department of Pediatric Emergency Medicine, Minneapolis, Minnesota
| | - Donna M Milner
- Children's Hospitals and Clinics of Minnesota, Department of Pediatric Emergency Medicine, Minneapolis, Minnesota
| | - Constantinos Voulgaropoulos
- Children's Hospitals and Clinics of Minnesota, McNeely Pediatric Diabetes Center and Endocrinology Clinic, Minneapolis, Minnesota
| | - Gretchen J Cutler
- Children's Hospitals and Clinics of Minnesota, Department of Pediatric Emergency Medicine, Minneapolis, Minnesota
| | - Anupam B Kharbanda
- Children's Hospitals and Clinics of Minnesota, Department of Pediatric Emergency Medicine, Minneapolis, Minnesota
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Sills MR, Hall M, Colvin JD, Macy ML, Cutler GJ, Bettenhausen JL, Morse RB, Auger KA, Raphael JL, Gottlieb LM, Fieldston ES, Shah SS. Association of Social Determinants With Children's Hospitals' Preventable Readmissions Performance. JAMA Pediatr 2016; 170:350-8. [PMID: 26881387 DOI: 10.1001/jamapediatrics.2015.4440] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Performance-measure risk adjustment is of great interest to hospital stakeholders who face substantial financial penalties from readmissions pay-for-performance (P4P) measures. Despite evidence of the association between social determinants of health (SDH) and individual patient readmission risk, the effect of risk adjusting for SDH on readmissions P4P penalties to hospitals is not well understood. OBJECTIVE To determine whether risk adjustment for commonly available SDH measures affects the readmissions-based P4P penalty status of a national cohort of children's hospitals. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 43 free-standing children's hospitals within the Pediatric Health Information System database in the calendar year 2013. We evaluated hospital discharges from 2013 that met criteria for 3M Health Information Systems' potentially preventable readmissions measure for calendar year 2013. The analysis was conducted from July 2015 to August 2015. EXPOSURES Two risk-adjustment models: a baseline model adjusted for severity of illness and an SDH-enhanced model that adjusted for severity of illness and the following 4 SDH variables: race, ethnicity, payer, and median household income for the patient's home zip code. MAIN OUTCOMES AND MEASURES Change in a hospital's potentially preventable readmissions penalty status (ie, change in whether a hospital exceeded the penalty threshold) using an observed-to-expected potentially preventable readmissions ratio of 1.0 as a penalty threshold. RESULTS For the 179,400 hospital discharges from the 43 hospitals meeting inclusion criteria, median (interquartile range [IQR]) hospital-level percentages for the SDH variables were 39.2% nonwhite (n = 71,300; IQR, 28.6%-54.6%), 17.9% Hispanic (n = 32,060; IQR, 6.7%-37.0%), and 58.7% publicly insured (n = 106,116; IQR, 50.4%-67.8%). The hospital median household income for the patient's home zip code was $ 40,674 (IQR, $ 35,912-$ 46,190). When compared with the baseline model, adjustment for SDH resulted in a change in penalty status for 3 hospitals within the 15-day window (2 were no longer above the penalty threshold and 1 was newly penalized) and 5 hospitals within the 30-day window (3 were no longer above the penalty threshold and 2 were newly penalized). CONCLUSIONS AND RELEVANCE Risk adjustment for SDH changed hospitals' penalty status on a readmissions-based P4P measure. Without adjusting P4P measures for SDH, hospitals may receive penalties partially related to patient SDH factors beyond the quality of hospital care.
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Affiliation(s)
- Marion R Sills
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Matt Hall
- Children's Hospital Association, Overland Park, Kansas
| | - Jeffrey D Colvin
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City
| | - Michelle L Macy
- Department of Emergency Medicine, University of Michigan, Ann Arbor5Department of Pediatrics, University of Michigan, Ann Arbor
| | - Gretchen J Cutler
- Department of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis
| | - Jessica L Bettenhausen
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City
| | - Rustin B Morse
- Children's Health System of Texas, University of Texas Southwestern, Dallas
| | - Katherine A Auger
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Laura M Gottlieb
- Department of Family and Community Medicine, University of California at San Francisco
| | - Evan S Fieldston
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Samir S Shah
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Zonfrillo MR, Zaniletti I, Hall M, Fieldston ES, Colvin JD, Bettenhausen JL, Macy ML, Alpern ER, Cutler GJ, Raphael JL, Morse RB, Sills MR, Shah SS. Socioeconomic Status and Hospitalization Costs for Children with Brain and Spinal Cord Injury. J Pediatr 2016; 169:250-5. [PMID: 26563534 PMCID: PMC6180292 DOI: 10.1016/j.jpeds.2015.10.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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] [Received: 03/31/2015] [Revised: 09/17/2015] [Accepted: 10/09/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine if household income is associated with hospitalization costs for severe traumatic brain injury (TBI) and spinal cord injury (SCI). STUDY DESIGN Retrospective cohort study of inpatient, nonrehabilitation hospitalizations at 43 freestanding children's hospitals for patients <19 years old with unintentional severe TBI and SCI from 2009-2012. Standardized cost of care for hospitalizations was modeled using mixed-effects methods, adjusting for age, sex, race/ethnicity, primary payer, presence of chronic medical condition, mechanism of injury, injury severity, distance from residence to hospital, and trauma center level. Main exposure was zip code level median annual household income. RESULTS There were 1061 patients that met inclusion criteria, 833 with TBI only, 227 with SCI only, and 1 with TBI and SCI. Compared with those with the lowest-income zip codes, patients from the highest-income zip codes were more likely to be older, white (76.7% vs 50.4%), have private insurance (68.9% vs 27.9%), and live closer to the hospital (median distance 26.7 miles vs 81.2 miles). In adjusted models, there was no significant association between zip code level household income and hospitalization costs. CONCLUSIONS Children hospitalized with unintentional, severe TBI and SCI showed no difference in standardized hospital costs relative to a patient's home zip code level median annual household income. The association between household income and hospitalization costs may vary by primary diagnosis.
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Affiliation(s)
- Mark R Zonfrillo
- Department of Emergency Medicine and Injury Prevention Center, Hasbro Children's Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI.
| | | | - Matthew Hall
- Children's Hospital Association, Overland Park, KS
| | - Evan S Fieldston
- Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jeffrey D Colvin
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Jessica L Bettenhausen
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Michelle L Macy
- Department of Emergency Medicine, Child Health Evaluation and Research Unit, Division of General Pediatrics, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, MI
| | - Elizabeth R Alpern
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gretchen J Cutler
- Department of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Jean L Raphael
- Department of Pediatrics, Section on Academic General Pediatrics, Baylor College of Medicine, Houston, TX
| | | | | | - Samir S Shah
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
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Cutler GJ, Flood A, Dreyfus J, Ortega HW, Kharbanda AB. Emergency Department Visits for Self-Inflicted Injuries in Adolescents. Pediatrics 2015; 136:28-34. [PMID: 26077475 DOI: 10.1542/peds.2014-3573] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe emergency department (ED) visits for self-inflicted injury (SII) among adolescents, examine trends in SII mechanisms, and identify factors associated with increased risk. METHODS Analyses included patients aged 10 to 18 years from the National Trauma Data Bank, years 2009 to 2012. We used Cochran-Armitage trend tests to examine change over time and generalized linear models to identify risk factors for SII. RESULTS We examined 286,678 adolescent trauma patients, 3664 (1.3%) of whom sustained an SII. ED visits for SII increased from 2009 to 2012 (1.1% to 1.6%, P for trend ≤ .001), whereas self-inflicted firearm visits decreased (27.3% to 21.9%, P for trend = .02). The most common mechanism in males was firearm (34.4%), and in females, cut/pierce (48.0%). Odds of SII were higher in females (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.13-1.77), older adolescents (OR 2.73, 95% CI 2.38-3.14), adolescents with comorbid conditions (OR 1.64; 95% CI 1.49-1.80), and Asian adolescents (OR 1.67, 95% CI 1.35-2.08) and lower in African American adolescents (OR 0.78, 95% CI 0.70-0.87). Adolescents in the public or self-pay insurance category had higher odds of SII (OR 1.44, 95% CI 1.27-1.64) than those in the private insurance category (OR 1.15, 95% CI 1.01-1.31). Adolescents with an SII had higher odds of death than those with other injuries (OR 12.9, 95% CI 6.78-24.6). CONCLUSIONS We found a significant increase in the number of SIIs by adolescents that resulted in ED visits from 2009 to 2012. Although SIIs increased, we found a significant decrease in the percentage of adolescents who self-injured with a firearm. SIIs reflect a small percentage of ED visits, but these patients have dramatically higher odds of death.
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Affiliation(s)
| | - Andrew Flood
- Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Jill Dreyfus
- Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
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Sirard JR, Hannan PJ, Cutler GJ, Graham DJ, Neumark-Sztainer D. Evaluation of 2 self-report measures of physical activity with accelerometry in young adults. J Phys Act Health 2013; 10:85-96. [PMID: 22241145 PMCID: PMC3521871 DOI: 10.1123/jpah.10.1.85] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this paper is to evaluate self-reported physical activity of young adults using 1-week and 1-year recall measures with an accelerometer as the criterion measure. METHODS Participants were a subsample (N = 121, 24 ± 1.7 yrs) from a large longitudinal cohort study. Participants completed a detailed 1-year physical activity recall, wore an accelerometer for 1 week and then completed a brief 1-week physical activity recall when they returned the accelerometer. RESULTS Mean values for moderate-to-vigorous physical activity (MVPA) from the 3 instruments were 3.2, 2.2, and 13.7 hours/wk for the accelerometer, 1-week recall, and 1-year recall, respectively (all different from each other, P < .001). Spearman correlations for moderate, vigorous, and MVPA between the accelerometer and the 1-week recall (0.30, 0.50, and 0.40, respectively) and the 1-year recall (0.31, 0.42, and 0.44, respectively) demonstrated adequate validity. CONCLUSIONS Both recall instruments may be used for ranking physical activity at the group level. At the individual level, the 1-week recall performed much better in terms of absolute value of physical activity. The 1-year recall overestimated total physical activity but additional research is needed to fully test its validity.
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Affiliation(s)
- John R Sirard
- Kinesiology Program, Department of Human Services, University of Virginia, Curry School of Education
| | - Peter J Hannan
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Gretchen J Cutler
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Dan J Graham
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health
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Sirard JR, Cutler GJ, Hannan PJ, Graham DJ, Neumark-Sztainer D. Evaluation of Two Self-Report Measures of Physical Activity with Accelerometry in Young Adults. Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000401671.07274.c4] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
A diet-patterns approach has often been used to describe eating patterns in adults but has rarely been used in adolescents. We used principal components factor analysis to: 1) describe the dietary patterns of a cohort of ethnically diverse youth during early and middle adolescence; 2) examine if the patterns persisted 5 y later; and 3) study secular trends. Project EAT-I (Time 1) collected data on 4746 middle school (younger cohort) and high school (older cohort) students in 31 Minnesota schools in 1998-1999. Project EAT-II (Time 2) resurveyed 53% (n = 2516) of the original cohort in 2003-2004. Dietary intake was assessed at Time 1 and 2 using the Youth/Adolescent FFQ. We identified dietary patterns separately by cohort (older/younger) and gender (boys/girls). At Time 1, we identified 4 patterns in early and middle adolescents that were relatively consistent between boys and girls that we labeled vegetable, fruit, sweet/salty snack food, and starchy food. Longitudinal analyses indicated that patterns were relatively stable over 5 y, with the exception of a new fast food pattern. Examination of age-matched secular trends in middle adolescents (older cohort at Time 1, younger cohort at Time 2) showed similar patterns, with the exception of the fast food pattern that emerged at Time 2 among middle adolescent boys. We identified dietary patterns in this adolescent population that differed from those usually found in adults. Patterns were similar across gender and age cohorts and were relatively similar over time, with the exception a new fast food pattern.
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Affiliation(s)
- Gretchen J Cutler
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA.
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21
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Cutler GJ, Nettleton JA, Ross JA, Harnack LJ, Jacobs DR, Scrafford CG, Barraj LM, Mink PJ, Robien K. Dietary flavonoid intake and risk of cancer in postmenopausal women: the Iowa Women's Health Study. Int J Cancer 2008; 123:664-71. [PMID: 18491403 DOI: 10.1002/ijc.23564] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Flavonoids, which are found in certain plant foods, are thought to lower cancer risk through their antioxidant, antiestrogenic and antiproliferative properties. We examined the association of intake of total flavonoids and 7 flavonoid subclasses with risk of lung, colorectal, breast, pancreatic and upper aerodigestive cancer among women in a large prospective cohort study. Study participants were 34,708 postmenopausal women in the Iowa Women's Health Study who completed a food frequency questionnaire and were followed for cancer occurrence from 1986 through 2004. Flavonoid intake was estimated from 3 databases developed by the USDA Nutrient Data Laboratory (NDL). Hazard ratios (HR) for cancer risk were calculated across total flavonoid and flavonoid subclass intake categories. Interactions between smoking history and flavonoid intake were also examined. After multivariable adjustment, lung cancer incidence was inversely associated with intakes of flavanones (HR = 0.68; 95% CI: 0.53-0.86, all results highest vs. lowest quintile) and proanthocyanidins (HR = 0.75; 95% CI: 0.57-0.97). Among current and past smokers, those with intakes in the highest quintile for flavanones (HR = 0.66; 95% CI: 0.50-0.86), and proanthocyanidins (HR = 0.66; 95% CI; 0.49-0.89) had significantly lower lung cancer incidence than those in the lowest quintile. Similar associations were not seen in never smokers. Isoflavone intake was inversely associated with overall cancer incidence (HR = 0.93, 95% CI: 0.86-1.00). This study provides further support for a beneficial effect of flavonoid intake on lung cancer risk, especially among current and past smokers.
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Affiliation(s)
- Gretchen J Cutler
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
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Robien K, Cutler GJ, Lazovich D. Vitamin D intake and breast cancer risk in postmenopausal women: the Iowa Women’s Health Study. Cancer Causes Control 2007; 18:775-82. [PMID: 17549593 DOI: 10.1007/s10552-007-9020-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Accepted: 05/07/2007] [Indexed: 10/23/2022]
Abstract
Vitamin D, a prosteroid hormone with anti-proliferative and pro-differentiation activity, is thought to act as a cancer chemopreventive agent. This study evaluated the association between vitamin D intake and breast cancer risk among women in a large prospective cohort study. A total of 34,321 postmenopausal women who had completed a questionnaire that included diet and supplement use were followed for breast cancer incidence from 1986 to 2004. Adjusted relative risks (RR) for breast cancer were calculated for dietary, supplemental, and total vitamin D intake among all women. The adjusted RR of breast cancer for women consuming >800 IU/day versus <400 IU/day total vitamin D was 0.89 (95% CI: 0.77-1.03). RRs were stronger among women with negative than positive ER or PR status. The association of high vitamin D intake with breast cancer was strongest in the first 5 years after baseline dietary assessment (RR = 0.66; 95% CI: 0.46-0.94 compared with lowest-intake group), and diminished over time. Changes in vitamin D intake over time might have contributed to the diminished association observed in later years. Vitamin D intake of >800 IU/day appears to be associated with a small decrease in risk of breast cancer among postmenopausal women. Studies evaluating all sources of vitamin D, especially sun exposure, are needed to fully understand the association between vitamin D and breast cancer risk.
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Affiliation(s)
- Kim Robien
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 1300 S. Second St., Suite 300, Minneapolis, MN 55454, USA.
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Cutler GJ, Cheever H. Shedding light on induced molting. J Am Vet Med Assoc 2000; 217:8-11. [PMID: 10909438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Droual R, Bickford AA, Cutler GJ. Local reaction and serological response in commercial layer chickens injected intramuscularly in the leg with oil-adjuvanted Mycoplasma gallisepticum bacterin. Avian Dis 1993; 37:1001-8. [PMID: 8141726] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The incidence of local vaccine reaction was investigated in three flocks of commercial layer chickens after they were vaccinated intramuscularly in the leg with oil-adjuvanted Mycoplasma gallisepticum (MG) bacterin by commercial crews. Local vaccine reaction typically involved swelling due to a granulomatous cellulitis in the connective tissue above the tibiotarsal joint of the vaccinated leg. Histopathology revealed that the inflammatory reaction was confined primarily to subcutis and muscle fascia and rarely extended into muscle fibers, tendons, or tendon sheaths. Movement of the vaccinated flocks from growing to laying houses was associated with a significant increase in the incidence and severity of leg swelling. Antibodies against MG as measured by the hemagglutination-inhibition test were significantly higher in chickens with severe leg swelling than in chickens without leg swelling.
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Affiliation(s)
- R Droual
- California Veterinary Diagnostic Laboratory System, University of California, Davis, Fresno 93725
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