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Williamson AA, Uwah EA, Min J, Zhang X, Griffis H, Cielo CM, Tapia IE, Fiks AG, Mindell JA. Diagnosis of sleep disorders in child healthcare settings. Sleep Med 2024; 119:80-87. [PMID: 38657437 DOI: 10.1016/j.sleep.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/04/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Sleep disorders impact at least 10 % of children, pose risks to overall wellbeing, and are key targets of preventive interventions. The objectives of this study were to describe the prevalence of pediatric sleep disorder diagnoses across sociodemographic characteristics and co-occurring conditions, and to explore potential sociodemographic disparities. METHODS Cross-sectional analysis of 12,394,902 children (0-17 years; 50.9 % Medicaid-insured) in the 2017 MarketScan database. Prevalence was assessed utilizing ICD-10 codes, with multivariate logistic regressions examining disparities (insurance coverage; race and ethnicity in Medicaid-insured) for diagnoses in ≥0.10 % of children. RESULTS The prevalence of sleep disorder diagnoses was 2.36 %. The most common diagnoses were obstructive sleep disordered breathing (oSDB, 1.17 %), unspecified sleep disorders (0.64 %), insomnia (0.52 %), and other SDB (0.10 %), with <0.10 % for all other diagnoses. Insomnia and parasomnias diagnoses were much lower than diagnostic estimates. Sleep diagnoses were more prevalent in Medicaid versus commercially insured youth, 2-5-year-olds, and in children with co-occurring medical, neurodevelopmental, or behavioral health conditions. Girls and boys were generally equally likely to be diagnosed with any sleep disorder. In Medicaid-insured children, white children were more likely to have any sleep diagnosis compared to all other racial and ethnic groups. Black/African American children were more likely than white children to have oSDB. CONCLUSIONS Compared to diagnostic estimates, claims data suggest sleep disorders are under-diagnosed, with notable sociodemographic disparities. Findings suggest a need for clinical resources to identify and address sleep disorders and to understand biases potentially driving disparities, given that sleep is a modifiable determinant of child wellbeing.
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Affiliation(s)
- Ariel A Williamson
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA; The Ballmer Institute for Children's Behavioral Health, University of Oregon, Portland, OR, USA.
| | - Eberechukwu A Uwah
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jungwon Min
- Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Xuemei Zhang
- Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather Griffis
- Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher M Cielo
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Ignacio E Tapia
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA; Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Alexander G Fiks
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Jodi A Mindell
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA; Department of Psychology, Saint Joseph's University, Philadelphia, PA, USA
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Lauridsen KG, Morgan RW, Berg RA, Niles DE, Kleinman ME, Zhang X, Griffis H, Del Castillo J, Skellett S, Lasa JJ, Raymond TT, Sutton RM, Nadkarni VM. Association Between Chest Compression Pause Duration and Survival After Pediatric In-Hospital Cardiac Arrest. Circulation 2024. [PMID: 38563137 DOI: 10.1161/circulationaha.123.066882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/27/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The association between chest compression (CC) pause duration and pediatric in-hospital cardiac arrest survival outcomes is unknown. The American Heart Association has recommended minimizing pauses in CC in children to <10 seconds, without supportive evidence. We hypothesized that longer maximum CC pause durations are associated with worse survival and neurologicalal outcomes. METHODS In this cohort study of index pediatric in-hospital cardiac arrests reported in pediRES-Q (Quality of Pediatric Resuscitation in a Multicenter Collaborative) from July of 2015 through December of 2021, we analyzed the association in 5-second increments of the longest CC pause duration for each event with survival and favorable neurological outcome (Pediatric Cerebral Performance Category ≤3 or no change from baseline). Secondary exposures included having any pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds per 2 minutes. RESULTS We identified 562 index in-hospital cardiac arrests (median [Q1, Q3] age 2.9 years [0.6, 10.0], 43% female, 13% shockable rhythm). Median length of the longest CC pause for each event was 29.8 seconds (11.5, 63.1). After adjustment for confounders, each 5-second increment in the longest CC pause duration was associated with a 3% lower relative risk of survival with favorable neurological outcome (absolute risk reduction, 0.97 [95% CI, 0.95-0.99]; P=0.02). Longest CC pause duration was also associated with survival to hospital discharge (absolute risk reduction, 0.98 [95% CI, 0.96-0.99]; P=0.01) and return of spontaneous circulation (absolute risk reduction, 0.93 [95% CI, 0.91-0.94]; P<0.001). Secondary outcomes of any pause >10 seconds or >20 seconds and number of CC pauses >10 seconds and >20 seconds were each significantly associated with lower absolute risk reduction of return of spontaneous circulation, but not survival or neurological outcomes. CONCLUSIONS Each 5-second increment in longest CC pause duration during pediatric in-hospital cardiac arrest was associated with lower chance of survival with favorable neurological outcome, survival to hospital discharge, and return of spontaneous circulation. Any CC pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds were significantly associated with lower adjusted probability of return of spontaneous circulation, but not survival or neurological outcomes.
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Affiliation(s)
- Kasper G Lauridsen
- Research Center for Emergency Medicine, Aarhus University, Denmark (K.G.L.)
- Department of Anesthesiology and Critical Care Medicine, Randers Regional Hospital, Denmark (K.G.L.)
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (K.G.L., R.W.M., R.A.B., D.E.N., R.M.S., V.M.N.)
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (K.G.L., R.W.M., R.A.B., D.E.N., R.M.S., V.M.N.)
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (K.G.L., R.W.M., R.A.B., D.E.N., R.M.S., V.M.N.)
| | - Dana E Niles
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (K.G.L., R.W.M., R.A.B., D.E.N., R.M.S., V.M.N.)
| | - Monica E Kleinman
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, MA (M.E.K.)
| | - Xuemei Zhang
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, PA (X.Z., H.G.)
| | - Heather Griffis
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, PA (X.Z., H.G.)
| | - Jimena Del Castillo
- Department of Pediatric Intensive Care, Hospital Maternoinfantil Gregorio Marañón, Madrid, Spain (J.D.C.)
| | - Sophie Skellett
- Department of Critical Care Medicine, Great Ormond Street Hospital for Children, London, England (S.S.)
| | - Javier J Lasa
- Divisions of Cardiology and Critical Care Medicine, Children's Medical Center, UT Southwestern Medical Center, Dallas, TX (J.J.L.)
| | - Tia T Raymond
- Department of Pediatrics, Cardiac Intensive Care, Medical City Children's Hospital, Dallas, TX (T.T.R.)
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (K.G.L., R.W.M., R.A.B., D.E.N., R.M.S., V.M.N.)
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine (K.G.L., R.W.M., R.A.B., D.E.N., R.M.S., V.M.N.)
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Weinreb SJ, Ampah SB, Okunowo O, Griffis H, Vetter VL. Longitudinal echocardiographic parameters before and after pacemaker placement in congenital complete heart block. Heart Rhythm 2024; 21:454-461. [PMID: 37981292 DOI: 10.1016/j.hrthm.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Congenital complete heart block (CCHB) is seen in 1:15,000-1:20,000 live births, with risk of left ventricular (LV) dysfunction or dilated cardiomyopathy in 7%-23% of subjects. OBJECTIVE The purpose of this study was to investigate serial changes in LV size and systolic function in paced CCHB subjects to examine the effect of time from pacemaker on echocardiographic parameters. METHODS Single-center retrospective cohort analysis of paced CCHB subjects was performed. Echocardiographic data were collected before and after pacemaker placement. Linear mixed effect regression of left ventricular end-diastolic dimension (LVEDD) z-score, left ventricular shortening fraction (LVSF), and left ventricular ejection fraction (LVEF) was performed, with slopes compared before and after pacemaker placement. RESULTS Of 114 CCHB subjects, 52 had echocardiographic data before and after pacemaker placement. Median age at CCHB diagnosis was 0.6 [interquartile range 0.0-3.5] years; age at pacemaker placement 3.4 [0.5-9.0] years; and pacing duration 10.8 [5.2-13.7] years. Estimated LVEDD z-score was 1.4 at pacemaker placement and decreased -0.08 per year (95% confidence interval [CI] -0.12 to -0.04; P = .002) to 0.2 (95% CI -0.3 to +0.3) 15 years postplacement. Estimated LVSF decreased -1.1% per year (95% CI -1.7% to -0.6%; P <.001) from 6 months prepacemaker placement to 34% (95% CI 32%-37%) 4 years postplacement. There was no significant change in LVSF between 4 and 15 years postplacement. Estimated LVEF did not change significantly after pacemaker placement, with estimated LVEF 59% (95% CI 55%-62%) 15 years postplacement. CONCLUSION In 52 paced CCHB subjects, estimated LVEDD z-score decreased significantly after pacemaker placement, and estimated LVSF and LVEF remained within normal limits at 15 years postpacemaker placement.
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Affiliation(s)
- Scott J Weinreb
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Steve B Ampah
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Oluwatimilehin Okunowo
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute of City of Hope, Duarte, California
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Victoria L Vetter
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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O'Brien EM, Stricker PA, Harris KA, Liu H, Griffis H, Muhly WT. Perioperative Management and Outcomes in Patients With Autism Spectrum Disorder: A Retrospective Cohort Study. Anesth Analg 2024; 138:438-446. [PMID: 37010953 DOI: 10.1213/ane.0000000000006426] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurocognitive disorder characterized by impairments in communication and socialization. There are little data comparing the differences in perioperative outcomes in children with and without ASD. We hypothesized that children with ASD would have higher postoperative pain scores than those without ASD. METHODS Pediatric patients undergoing ambulatory tonsillectomy/adenoidectomy, ophthalmological surgery, general surgery, and urologic procedures between 2016 and 2021 were included in this retrospective cohort study. ASD patients, defined by International Classification of Diseases-9/10 codes, were compared to controls utilizing inverse probability of treatment weighting based on surgical category/duration, age, sex, race and ethnicity, anesthetizing location, American Society of Anesthesiology physical status, intraoperative opioid dose, and intraoperative dexmedetomidine dose. The primary outcome was the maximum postanesthesia care unit (PACU) pain score, and secondary outcomes included premedication administration, behavior at induction, PACU opioid administration, postoperative vomiting, emergence delirium, and PACU length of stay. RESULTS Three hundred thirty-five children with ASD and 11,551 non-ASD controls were included. Maximum PACU pain scores in the ASD group were not significantly higher than controls (median, 5; interquartile range [IQR], 0-8; ASD versus median, 5; IQR, 0-8 controls; median difference [95% confidence interval {CI}] of 0 [-1.1 to 1.1]; P = .66). There was no significant difference in the use of premedication (96% ASD versus 95% controls; odds ratio [OR], 1.5; [95% CI, 0.9-2.7]; P = .12), but the ASD cohort had significantly higher odds of receiving an intranasal premedication (4.2% ASD versus 1.2% controls; OR, 3.5 [95% CI, 1.8-6.8]; P < .001) and received ketamine significantly more frequently (0.3% ASD versus <0.1% controls; P < .001). Children with ASD were more likely to have parental (4.9% ASD versus 1.0% controls; OR, 5 [95% CI, 2.1-12]; P < .001) and child life specialist (1.3% ASD versus 0.1% controls; OR, 9.9 [95% CI, 2.3-43]; P < .001) presence at induction, but were more likely to have a difficult induction (11% ASD versus 3.4% controls; OR, 3.42 [95% CI, 1.7-6.7]; P < .001). There were no significant differences in postoperative opioid administration, emergence delirium, vomiting, or PACU length of stay between cohorts. CONCLUSIONS We found no difference in maximum PACU pain scores in children with ASD compared to a similarly weighted cohort without ASD. Children with ASD had higher odds of a difficult induction despite similar rates of premedication administration, and significantly higher parental and child life specialist presence at induction. These findings highlight the need for future research to develop evidence-based interventions to optimize the perioperative care of this population.
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Affiliation(s)
- Elizabeth M O'Brien
- From the Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul A Stricker
- From the Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathleen A Harris
- From the Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hongyan Liu
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heather Griffis
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wallis T Muhly
- From the Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Walter JK, Feudtner C, Cetin A, DeWitt AG, Zhou M, Montoya-Williams D, Olsen R, Griffis H, Williams C, Costarino A. Parental communication satisfaction with the clinical team in the paediatric cardiac ICU. Cardiol Young 2024; 34:282-290. [PMID: 37357911 PMCID: PMC10749983 DOI: 10.1017/s1047951123001555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Understanding parents' communication preferences and how parental and child characteristics impact satisfaction with communication is vital to mitigate communication challenges in the cardiac ICU. METHODS This cross-sectional survey was conducted from January 2019 to March 2020 in a paediatric cardiac ICU with parents of patients admitted for at least two weeks. Family satisfaction with communication with the medical team was measured using the Communication Assessment Tool for Team settings. Clinical characteristics were collected via Epic, Pediatric Cardiac Critical Care Consortium local entry and Society for Thoracic Surgeons Congenital Heart Surgery Databases. Associations between communication score and parental mood, stress, perceptions of clinical care, and demographic characteristics along with patient demographic and clinical characteristics were examined. Multivariable ordinal models were conducted with characteristics significant in bivariate analysis. RESULTS In total, 93 parents of 84 patients (86% of approached) completed surveys. Parents were 63% female and 70% White. Seventy per cent of patients were <6 months old at admission, 25% had an extracardiac abnormality, and 80% had a cardiac surgery this admission. Parents of children with higher pre-surgical risk of mortality scores (OR 2.875; 95%CI 1.076-7.678), presence of surgical complications (72 [63.0, 75.0] vs. 64 [95%CI 54.6, 73] (p = 0.0247)), and greater satisfaction with care in the ICU (r = 0.93922; p < 0.0001) had significantly higher communication scores. CONCLUSION These findings can prepare providers for scenarios with higher risk for communication challenges and demonstrate the need for further investigation into interventions that reduce parental anxiety and improve communication for patients with unexpected clinical trajectories.
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Affiliation(s)
- Jennifer K Walter
- Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chris Feudtner
- Pediatric Advanced Care Team, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Arzu Cetin
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aaron G DeWitt
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle Zhou
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diana Montoya-Williams
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rob Olsen
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine Williams
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrew Costarino
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Dashefsky HS, Liu H, Hayes K, Griffis H, Vaughan M, Chilutti M, Balamuth F, Stinson HR, Fitzgerald JC, Carlton EF, Weiss SL. Frequency of and Risk Factors Associated With Hospital Readmission After Sepsis. Pediatrics 2023; 152:e2022060819. [PMID: 37366012 PMCID: PMC10553743 DOI: 10.1542/peds.2022-060819] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/07/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVES Although children who survive sepsis are at risk for readmission, identification of patient-level variables associated with readmission has been limited by administrative datasets. We determined frequency and cause of readmission within 90 days of discharge and identified patient-level variables associated with readmission using a large, electronic health record-based registry. METHODS This retrospective observational study included 3464 patients treated for sepsis or septic shock between January 2011 and December 2018 who survived to discharge at a single academic children's hospital. We determined frequency and cause of readmission through 90 days post-discharge and identified patient-level variables associated with readmission. Readmission was defined as inpatient treatment within 90 days post-discharge from a prior sepsis hospitalization. Outcomes were frequency of and reasons for 7-, 30-, and 90-day (primary) readmission. Patient variables were tested for independent associations with readmission using multivariable logistic regression. RESULTS Following index sepsis hospitalization, frequency of readmission at 7, 30, and 90 days was 7% (95% confidence interval 6%-8%), 20% (18%-21%), and 33% (31%-34%). Variables independently associated with 90-day readmission were age ≤ 1 year, chronic comorbid conditions, lower hemoglobin and higher blood urea nitrogen at sepsis recognition, and persistently low white blood cell count ≤ 2 thous/µL. These variables explained only a small proportion of overall risk (pseudo-R2 range 0.05-0.13) and had moderate predictive validity (area under the receiver operating curve range 0.67-0.72) for readmission. CONCLUSIONS Children who survive sepsis were frequently readmitted, most often for infections. Risk for readmission was only partly indicated by patient-level variables.
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Affiliation(s)
| | - Hongyan Liu
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Marianne Chilutti
- Biomedical and Health Informatics
- Arcus Program, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Hannah R Stinson
- Departments of Anesthesiology and Critical Care
- Pediatric Sepsis Program
| | | | - Erin F Carlton
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Scott L Weiss
- Departments of Anesthesiology and Critical Care
- Pediatric Sepsis Program
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Raphael JL, Freed GL, Ampah SB, Griffis H, Walker-Harding LR, Ellison AM. Faculty Perspectives on Diversity, Equity, and Inclusion: Building a Foundation for Pediatrics. Pediatrics 2023; 151:190901. [PMID: 36970859 DOI: 10.1542/peds.2022-058394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/19/2022] [Indexed: 04/04/2023] Open
Abstract
ABSTRACT Pediatric departments and children's hospitals (hereafter pediatric academic settings) increasingly promote the tenets of diversity, equity, and inclusion (DEI) as guiding principles to shape the mission areas of clinical care, education, research, and advocacy. Integrating DEI across these domains has the potential to advance health equity and workforce diversity. Historically, initiatives toward DEI have been fragmented with efforts predominantly led by individual faculty or subgroups of faculty with little institutional investment or strategic guidance. In many instances, there is a lack of understanding or consensus regarding what constitutes DEI activities, who engages in DEI activities, how faculty feel about their engagement, and what is an appropriate level of support. Concerns also exist that DEI work falls disproportionately to racial and ethnic groups underrepresented in medicine, exacerbating what is termed the minority tax. Despite these concerns, current literature lacks quantitative data characterizing such efforts and their potential impact on the minority tax. As pediatric academic settings invest in DEI programs and leadership roles, there is imperative to develop and use tools that can survey faculty perspectives, assess efforts, and align DEI efforts between academic faculty and health systems. Our exploratory assessment among academic pediatric faculty demonstrates that much of the DEI work in pediatric academic settings is done by a small number of individuals, predominantly Black faculty, with limited institutional support or recognition. Future efforts should focus on expanding participation among all groups and increasing institutional engagement.
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Affiliation(s)
- Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Gary L Freed
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Angela M Ellison
- Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Kirschen MP, Berman JI, Liu H, Ouyang M, Mondal A, Griffis H, Levow C, Winters M, Lang SS, Huh J, Huang H, Berg RA, Vossough A, Topjian A. Association Between Quantitative Diffusion-Weighted Magnetic Resonance Neuroimaging and Outcome After Pediatric Cardiac Arrest. Neurology 2022; 99:e2615-e2626. [PMID: 36028319 PMCID: PMC9754647 DOI: 10.1212/wnl.0000000000201189] [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] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Diffusion MRI can quantify the extent of hypoxic-ischemic brain injury after cardiac arrest. Our objective was to determine the association between the adult-derived threshold of apparent diffusion coefficient (ADC) <650 × 10-6 mm2/s in >10% of brain tissue and an unfavorable outcome after pediatric cardiac arrest. Since ADC decreases exponentially as a function of increasing age, we determined the association between (1) having >10% of brain tissue below a novel age-dependent ADC threshold, and (2) age-normalized whole-brain mean ADC and unfavorable outcome. METHODS This was a retrospective study of patients aged ≤18 years who had cardiac arrest and a clinically obtained brain MRI within 7 days. The primary outcome was unfavorable neurologic status at hospital discharge based on the Pediatric Cerebral Performance Category score. ADC images were extracted from 3-direction diffusion imaging. We determined whether each patient had >10% of voxels with an ADC below prespecified thresholds. We computed the whole-brain mean ADC for each patient. RESULTS One hundred thirty-four patients were analyzed. Patients with ADC <650 × 10-6 mm2/s in >10% of voxels had 15 times higher odds (95% CI 5-65) of an unfavorable outcome compared with patients with ADC <650 × 10-6 mm2/s (area under the receiver operating characteristic curve [AUROC] 0.72 [95% CI 0.63-0.80]). These ADC criteria had a sensitivity and specificity of 0.49 and 0.94, respectively, and positive and negative predictive values of 0.93 and 0.52, respectively, for an unfavorable outcome. The age-dependent ADC threshold that yielded optimal sensitivity and specificity for unfavorable outcomes was <300 × 10-6 mm2/s below each patient's predicted whole-brain mean ADC. The sensitivity, specificity, and positive and negative predictive values for this ADC threshold were 0.53, 0.96, 0.96, and 0.54, respectively (odds ratio [OR] 26.4 [95% CI 7.5-168.3]; AUROC 0.74 [95% CI 0.66-0.83]). Lower age-normalized whole-brain mean ADC was also associated with an unfavorable outcome (OR 0.42 [0.24-0.64], AUROC 0.76 [95% CI 0.66-0.82]). DISCUSSION Quantitative diffusion thresholds on MRI within 7 days after cardiac arrest were associated with an unfavorable outcome in children. The age-independent ADC threshold was highly specific for predicting an unfavorable outcome. However, the specificity and sensitivity increased when using age-dependent ADC thresholds. Age-dependent ADC thresholds may improve prognostic accuracy and require further investigation in larger cohorts. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that quantitative diffusion-weighted imaging within 7 days postarrest can predict an unfavorable clinical outcome in children.
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Affiliation(s)
- Matthew P Kirschen
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
| | - Jeffrey I Berman
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Hongyan Liu
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Minhui Ouyang
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Antara Mondal
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Heather Griffis
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Cindee Levow
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Madeline Winters
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Shih-Shan Lang
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jimmy Huh
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Hao Huang
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Robert A Berg
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Arastoo Vossough
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alexis Topjian
- From the Departments of Anesthesiology and Critical Care Medicine (M.P.K., C.L., M.W., J.H., R.A.B., A.T.), and Radiology (J.I.B., M.O., H.H., A.V.); Data Science and Biostatistics Unit (H.L., A.M., H.G.), Department of Biomedical and Health Informatics, and Department of Neurosurgery (S.-S.L.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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9
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Mazandi VM, Lang SS, Rahman RK, Nishisaki A, Beaulieu F, Zhang B, Griffis H, Tucker AM, Storm PB, Heuer GG, Gajjar AA, Ampah SB, Kirschen MP, Topjian AA, Yuan I, Francoeur C, Kilbaugh TJ, Huh JW. Co-administration of Ketamine in Pediatric Patients with Neurologic Conditions at Risk for Intracranial Hypertension. Neurocrit Care 2022; 38:242-253. [PMID: 36207491 DOI: 10.1007/s12028-022-01611-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/15/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND Ketamine has traditionally been avoided as an induction agent for tracheal intubation in patients with neurologic conditions at risk for intracranial hypertension due to conflicting data in the literature. The objective of this study was to evaluate and compare the effects of ketamine versus other medications as the primary induction agent on peri-intubation neurologic, hemodynamic and respiratory associated events in pediatric patients with neurologic conditions at risk for intracranial hypertension. METHODS This retrospective observational study enrolled patients < 18 years of age at risk for intracranial hypertension who were admitted to a quaternary children's hospital between 2015 and 2020. Associated events included neurologic, hemodynamic and respiratory outcomes comparing primary induction agents of ketamine versus non-ketamine for tracheal intubation. RESULTS Of 143 children, 70 received ketamine as the primary induction agent prior to tracheal intubation. Subsequently after tracheal intubation, all the patients received adjunct analgesic and sedative medications (fentanyl, midazolam, and/or propofol) at doses that were inadequate to induce general anesthesia but would keep them comfortable for further diagnostic workup. There were no significant differences between associated neurologic events in the ketamine versus non-ketamine groups (p = 0.42). This included obtaining an emergent computed tomography scan (p = 0.28), an emergent trip to the operating room within 5 h of tracheal intubation (p = 0.6), and the need for hypertonic saline administration within 15 min of induction drug administration for tracheal intubation (p = 0.51). There were two patients who had clinical and imaging evidence of herniation, which was not more adversely affected by ketamine compared with other medications (p = 0.49). Of the 143 patients, 23 had pre-intubation and post-intubation intracranial pressure values recorded; 11 received ketamine, and 3 of these patients had intracranial hypertension that resolved or improved, whereas the remaining 8 children had intracranial pressure within the normal range that was not exacerbated by ketamine. There were no significant differences in overall associated hemodynamic or respiratory events during tracheal intubation and no 24-h mortality in either group. CONCLUSIONS The administration of ketamine as the primary induction agent prior to tracheal intubation in combination with other agents after tracheal intubation in children at risk for intracranial hypertension was not associated with an increased risk of peri-intubation associated neurologic, hemodynamic or respiratory events compared with those who received other induction agents.
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Affiliation(s)
- Vanessa M Mazandi
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, 6 Wood Center, Philadelphia, PA, 19104, USA.
| | - Shih-Shan Lang
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Raphia K Rahman
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Rowan School of Osteopathic Medicine, Stratford, NJ, USA
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, 6 Wood Center, Philadelphia, PA, 19104, USA
| | - Forrest Beaulieu
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, 6 Wood Center, Philadelphia, PA, 19104, USA.,Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bingqing Zhang
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander M Tucker
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Phillip B Storm
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Greg G Heuer
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Avi A Gajjar
- Division of Neurosurgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Chemistry, Union College, Schenectady, NY, USA
| | - Steve B Ampah
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew P Kirschen
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, 6 Wood Center, Philadelphia, PA, 19104, USA
| | - Alexis A Topjian
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, 6 Wood Center, Philadelphia, PA, 19104, USA
| | - Ian Yuan
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, 6 Wood Center, Philadelphia, PA, 19104, USA
| | - Conall Francoeur
- Department of Pediatrics, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
| | - Todd J Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, 6 Wood Center, Philadelphia, PA, 19104, USA
| | - Jimmy W Huh
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Boulevard, 6 Wood Center, Philadelphia, PA, 19104, USA
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10
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Reza N, Edwards JJ, Katcoff H, Mondal A, Griffis H, Rossano JW, Lin KY, Holzhauser HL, Wald JW, Owens AT, Cappola TP, Birati EY, Edelson JB. Sex Differences in Left Ventricular Assist Device-related Emergency Department Encounters in the United States. J Card Fail 2022; 28:1445-1455. [PMID: 35644307 PMCID: PMC10066657 DOI: 10.1016/j.cardfail.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 11/02/2021] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is a paucity of data regarding sex differences in the profiles and outcomes of ambulatory patients on left ventricular assist device (LVAD) support who present to the emergency department (ED). METHODS AND RESULTS We performed a retrospective analysis of 57,200 LVAD-related ED patient encounters from the 2010 to 2018 Nationwide Emergency Department Sample. International Classification of Diseases Clinical Modification, Ninth Revision and Tenth Revision, codes identified patients aged 18 years or older with LVADs and associated primary and comorbidity diagnoses. Clinical characteristics and outcomes were stratified by sex and compared. Multivariable logistic regression was used to evaluate predictors of hospital admission and death. Female patient encounters comprised 27.2% of ED visits and occurred at younger ages and more frequently with obesity and depression (all P < .01). There were no sex differences in presentation for device complication, stroke, infection, or heart failure (all P > .05); however, female patient encounters were more often respiratory- and genitourinary or gynecological related (both P < .01). After adjustment for age group, diabetes, depression, and hypertension, male patient encounters had a 38% increased odds of hospital admission (95% confidence interval 1.20-1.58), but there was no sex difference in the adjusted odds of death (odds ratio 1.11, 95% confidence interval 0.86-1.45). CONCLUSIONS Patient encounters of females on LVAD support have significantly different comorbidities and outcomes compared with males. Further inquiry into these sex differences is imperative to improve long-term outcomes.
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Affiliation(s)
- Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Jonathan J Edwards
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hannah Katcoff
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Antara Mondal
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heather Griffis
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph W Rossano
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kimberly Y Lin
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - H Luise Holzhauser
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joyce W Wald
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anjali T Owens
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas P Cappola
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edo Y Birati
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery, Poriya Medical Center, and Azrieli Faculty of Medicine, Bar-Ilan University, Israel
| | - Jonathan B Edelson
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Mataya L, Bittermann T, Quarshie WO, Griffis H, Srinivasan V, Rand EB, Alcamo AM. Status 1B designation does not adequately prioritize children with acute-on-chronic liver failure for liver transplantation. Liver Transpl 2022; 28:1288-1298. [PMID: 35188336 DOI: 10.1002/lt.26436] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/25/2022] [Accepted: 02/14/2022] [Indexed: 02/07/2023]
Abstract
Acute-on-chronic liver failure (ACLF) is an acute decompensation of chronic liver disease leading to multiorgan failure and mortality. The objective of this study was to evaluate characteristics and outcomes of children with ACLF who are at the highest priority for liver transplantation (LT) on the United Network for Organ Sharing (UNOS) database-listed as status 1B. The characteristics and outcomes of 478 children with ACLF listed as status 1B on the UNOS LT waiting list from 2007-2019 were compared with children with similar or higher priority listing for transplant: 929 with acute liver failure (ALF) listed as status 1A and 808 with metabolic diseases and malignancies listed as status 1B (termed "non-ACLF"). Children with ACLF had comparable rates of cumulative organ failures compared with ALF (45% vs. 44%; p > 0.99) listings, but higher than non-ACLF (45% vs. 1%; p < 0.001). ACLF had the lowest LT rate (79%, 84%, 95%; p < 0.001), highest pre-LT mortality (20%, 11%, 1%; p < 0.001), and longest waitlist time (57, 3, 56 days; p < 0.001), and none recovered without LT (0%, 4%, 1%; p < 0.001). In survival analyses, ACLF was associated with an increased adjusted hazard ratio (HR) for post-LT mortality (HR, 1.50 vs. ALF [95% confidence interval, CI, 1.02-2.19; p = 0.04] and HR, 1.64 vs. non-ACLF [95% CI, 1.15-2.34; p = 0.01]). ACLF has the least favorable waitlist and post-LT outcomes of all patients who are status 1A/1B. Increased prioritization on the LT waiting list may offer children with ACLF an opportunity for enhanced outcomes.
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Affiliation(s)
- Leslie Mataya
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Therese Bittermann
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - William O Quarshie
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Heather Griffis
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Vijay Srinivasan
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth B Rand
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alicia M Alcamo
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Nye RT, Hill DL, Carroll KW, Boyden JY, Katcoff H, Griffis H, Campos D, Hall M, Wolfe J, Feudtner C. The Design of a Data Management System for a Multicenter Palliative Care Cohort Study. J Pain Symptom Manage 2022; 64:e53-e60. [PMID: 35339611 PMCID: PMC10484234 DOI: 10.1016/j.jpainsymman.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/06/2021] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Prospective cohort studies of individuals with serious illness and their family members, such as children receiving palliative care and their parents, pose challenges regarding data management. OBJECTIVE To describe the design and lessons learned regarding the data management system for the Pediatric Palliative Care Research Network's Shared Data and Research (SHARE) project, a multicenter prospective cohort study of children receiving pediatric palliative care (PPC) and their parents, and to describe important attributes of this system, with specific considerations for the design of future studies. METHODS The SHARE study consists of 643 PPC patients and up to two of their parents who enrolled from April 2017 to December 2020 at seven children's hospitals across the United States. Data regarding demographics, patient symptoms, goals of care, and other characteristics were collected directly from parents or patients at 6 timepoints over a 24-month follow-up period and stored electronically in a centralized location. Using medical record numbers, primary collected data was linked to administrative hospitalization data containing diagnostic and procedure codes and other data elements. Important attributes of the data infrastructure include linkage of primary and administrative data; centralized availability of multilingual questionnaires; electronic data collection and storage system; time-stamping of instrument completion; and a separate but connected study administrative database used to track enrollment. CONCLUSIONS Investigators planning future multicenter prospective cohort studies can consider attributes of the data infrastructure we describe when designing their data management system.
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Affiliation(s)
- Russell T Nye
- Justin Ingerman Center for Palliative Care (R.T.N., D.L.H., K.W.C., J.Y.B., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Data Science and Biostatistics Unit (R.T.N., H.K., H.G.), Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
| | - Douglas L Hill
- Justin Ingerman Center for Palliative Care (R.T.N., D.L.H., K.W.C., J.Y.B., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of General Pediatrics (D.L.H., J.Y.B., C.F.), The Children's Hospital of Philadelphia Philadelphia, Pennsylvania, USA
| | - Karen W Carroll
- Justin Ingerman Center for Palliative Care (R.T.N., D.L.H., K.W.C., J.Y.B., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jackelyn Y Boyden
- Justin Ingerman Center for Palliative Care (R.T.N., D.L.H., K.W.C., J.Y.B., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of General Pediatrics (D.L.H., J.Y.B., C.F.), The Children's Hospital of Philadelphia Philadelphia, Pennsylvania, USA
| | - Hannah Katcoff
- Data Science and Biostatistics Unit (R.T.N., H.K., H.G.), Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Heather Griffis
- Data Science and Biostatistics Unit (R.T.N., H.K., H.G.), Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Diego Campos
- Department of Biomedical and Health Informatics (D.C.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Matt Hall
- Children's Hospital Association (M.H.), Lenexa, Kansas, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care (J.W.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital (J.W.), Boston, Massachusetts, USA
| | - Chris Feudtner
- Justin Ingerman Center for Palliative Care (R.T.N., D.L.H., K.W.C., J.Y.B., C.F.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of General Pediatrics (D.L.H., J.Y.B., C.F.), The Children's Hospital of Philadelphia Philadelphia, Pennsylvania, USA
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13
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Vetter VL, Griffis H, Dalldorf KF, Naim MY, Rossano J, Vellano K, McNally B, Glatz AC. Impact of State Laws: CPR Education in High Schools. J Am Coll Cardiol 2022; 79:2140-2143. [PMID: 35618352 DOI: 10.1016/j.jacc.2022.03.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Victoria L Vetter
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Heather Griffis
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine F Dalldorf
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maryam Y Naim
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph Rossano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Bryan McNally
- CARES Surveillance Group; Emory University, Woodruff Health Sciences Center, Atlanta, Georgia, USA; Rollins School of Public Health, Atlanta, Georgia, USA
| | - Andrew C Glatz
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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14
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Lauridsen KG, Lasa JJ, Raymond TT, Yu P, Niles D, Sutton RM, Morgan RW, Fran Hazinski M, Griffis H, Hanna R, Zhang X, Berg RA, Nadkarni VM. Association of Chest Compression Pause Duration Prior to E-CPR Cannulation with Cardiac Arrest Survival Outcomes. Resuscitation 2022; 177:85-92. [PMID: 35588971 DOI: 10.1016/j.resuscitation.2022.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To characterize chest compression (CC) pause duration during the last 5 minutes of pediatric cardiopulmonary resuscitation (CPR) prior to extracorporeal-CPR (E-CPR) cannulation and the association with survival outcomes. METHODS Cohort study from a resuscitation quality collaborative including pediatric E-CPR cardiac arrest events ≥10 min with CPR quality data. We characterized CC interruptions during the last 5 min of defibrillator-electrode recorded CPR (prior to cannulation) and assessed the association between the longest CC pause duration and survival outcomes using multivariable logistic regression. RESULTS Of 49 E-CPR events, median age was 2.0 [Q1, Q3: 0.6, 6.6] years, 55% (27/49) survived to hospital discharge and 18/49 (37%) with favorable neurological outcome. Median duration of CPR was 51 [43, 69] min. During the last 5 min of recorded CPR prior to cannulation, median duration of the longest CC pause was 14.0 [6.3, 29.4] sec: 66% >10 sec, 25% >29 sec, 14% >60 sec, and longest pause 168 sec. Following planned adjustment for known confounders of age and CPR duration, each 5-sec increase in longest CC pause duration was associated with lower odds of survival to hospital discharge [adjusted OR 0.89, 95%CI: 0.79-0.99] and lower odds of survival with favorable neurological outcome [adjusted OR 0.77, 95%CI: 0.60-0.98]. CONCLUSIONS Long CC pauses were common during the last 5 min of recorded CPR prior to E-CPR cannulation. Following adjustment for age and CPR duration, each 5-second incremental increase in longest CC pause duration was associated with significantly decreased rates of survival and favorable neurological outcome.
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Affiliation(s)
- Kasper G Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Emergency Department, Randers Regional Hospital, Randers, Denmark; Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA.
| | - Javier J Lasa
- Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, USA
| | - Tia T Raymond
- Department of Pediatrics, Cardiac Intensive Care, Medical City Children's Hospital, Dallas, USA
| | - Priscilla Yu
- Dept of Pediatrics, Division of Critical Care Medicine, UT Southwestern Medical Center, Dallas, USA
| | - Dana Niles
- Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Robert M Sutton
- Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Ryan W Morgan
- Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Mary Fran Hazinski
- Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Richard Hanna
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Xuemei Zhang
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Robert A Berg
- Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Vinay M Nadkarni
- Center for Pediatric Resuscitation, Children's Hospital of Philadelphia, Philadelphia, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
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15
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Mehta SD, Muthu N, Yehya N, Galligan M, Porter E, McGowan N, Papili K, Favatella D, Liu H, Griffis H, Bonafide CP, Sutton RM. Leveraging EHR Data to Evaluate the Association of Late Recognition of Deterioration With Outcomes. Hosp Pediatr 2022; 12:447-460. [PMID: 35470399 DOI: 10.1542/hpeds.2021-006363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Emergency transfers (ETs), deterioration events with late recognition requiring ICU interventions within 1 hour of transfer, are associated with adverse outcomes. We leveraged electronic health record (EHR) data to assess the association between ETs and outcomes. We also evaluated the association between intervention timing (urgency) and outcomes. METHODS We conducted a propensity-score-matched study of hospitalized children requiring ICU transfer between 2015 and 2019 at a single institution. The primary exposure was ET, automatically classified using Epic Clarity Data stored in our enterprise data warehouse endotracheal tube in lines/drains/airway flowsheet, vasopressor in medication administration record, and/or ≥60 ml/kg intravenous fluids in intake/output flowsheets recorded within 1 hour of transfer. Urgent intervention was defined as interventions within 12 hours of transfer. RESULTS Of 2037 index transfers, 129 (6.3%) met ET criteria. In the propensity-score-matched cohort (127 ET, 374 matched controls), ET was associated with higher in-hospital mortality (13% vs 6.1%; odds ratio, 2.47; 95% confidence interval [95% CI], 1.24-4.9, P = .01), longer ICU length of stay (subdistribution hazard ratio of ICU discharge 0.74; 95% CI, 0.61-0.91, P < .01), and longer posttransfer length of stay (SHR of hospital discharge 0.71; 95% CI, 0.56-0.90, P < .01). Increased intervention urgency was associated with increased mortality risk: 4.1% no intervention, 6.4% urgent intervention, and 10% emergent intervention. CONCLUSIONS An EHR measure of deterioration with late recognition is associated with increased mortality and length of stay. Mortality risk increased with intervention urgency. Leveraging EHR automation facilitates generalizability, multicenter collaboratives, and metric consistency.
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Affiliation(s)
- Sanjiv D Mehta
- aDepartments of Anesthesiology and Critical Care Medicine
| | | | - Nadir Yehya
- aDepartments of Anesthesiology and Critical Care Medicine
- dDepartment of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Ezra Porter
- eCenter for Healthcare Quality and Analytics
| | | | - Kelly Papili
- aDepartments of Anesthesiology and Critical Care Medicine
| | - Dana Favatella
- gCritical Care Center for Evidence and Outcomes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hongyan Liu
- hBiomedical and Health Informatics, Data Science and Biostatistics Unit
| | - Heather Griffis
- hBiomedical and Health Informatics, Data Science and Biostatistics Unit
| | | | - Robert M Sutton
- aDepartments of Anesthesiology and Critical Care Medicine
- dDepartment of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Mejia EJ, Lin KY, Okunowo O, Iacobellis KA, Matesanz SE, Brandsema JF, Wittlieb-Weber CA, Katcoff H, Griffis H, Edelson JB. Health Care Use of Cardiac Specialty Care in Children With Muscular Dystrophy in the United States. J Am Heart Assoc 2022; 11:e024722. [PMID: 35411787 PMCID: PMC9238456 DOI: 10.1161/jaha.121.024722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Duchenne and Becker muscular dystrophy are progressive disorders associated with cardiac mortality. Guidelines recommend routine surveillance; we assess cardiac resource use and identify gaps in care delivery. Methods and Results Male patients, aged 1 to 18 years, with Duchenne and Becker muscular dystrophy between January 2013 and December 2017 were identified in the IBM MarketScan Research Database. The cohort was divided into <10 and 10 to 18 years of age. The primary outcome was rate of annual health care resource per person year. Resource use was assessed for place of service, cardiac testing, and medications. Adjusted incidence rate ratios (IRRs) were estimated using a Poisson regression model. Medication use was measured by proportion of days covered. There were 1386 patients with a median follow‐up time of 3.0 years (interquartile range, 1.9–4.7 years). Patients in the 10 to 18 years group had only 0.40 (95% CI, 0.35–0.45) cardiology visits per person year and 0.66 (95% CI, 0.62–0.70) echocardiography/magnetic resonance imaging per person year. Older patients had higher rates of inpatient admissions (IRR, 1.46; 95% CI, 1.03–2.09), outpatient cardiology visits (IRR, 2.0; 95% CI, 1.66–2.40), cardiac imaging (IRR, 1.59; 95% CI, 1.40–1.80), and Holter monitoring (IRR, 3.33; 95% CI, 2.35–4.73). A proportion of days covered >80% for angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers was observed in 13.6% (419/3083) of total person years among patients in the 10 to 18 years group. Conclusions Children 10 to 18 years of age have higher rates of cardiac resource use compared with those <10 years of age. However, rates in both age groups fall short of guidelines. Opportunities exist to identify barriers to resource use and optimize cardiac care for patients with Duchenne and Becker muscular dystrophy.
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Affiliation(s)
- Erika J Mejia
- Division of Cardiology Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Kimberly Y Lin
- Division of Cardiology Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Oluwatimilehin Okunowo
- Data Science & Biostatistics Unit Department of Biomedical and Health Informatics Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Katherine A Iacobellis
- Division of Cardiology Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Susan E Matesanz
- Division of Neurology Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - John F Brandsema
- Division of Neurology Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Carol A Wittlieb-Weber
- Division of Cardiology Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Hannah Katcoff
- Data Science & Biostatistics Unit Department of Biomedical and Health Informatics Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Heather Griffis
- Data Science & Biostatistics Unit Department of Biomedical and Health Informatics Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Jonathan B Edelson
- Division of Cardiology Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
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17
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Becker AE, Teixeira SR, Lunig NA, Mondal A, Fitzgerald JC, Topjian AA, Weiss SL, Griffis H, Schramm SE, Traynor DM, Vossough A, Kirschen MP. Sepsis-Related Brain MRI Abnormalities Are Associated With Mortality and Poor Neurological Outcome in Pediatric Sepsis. Pediatr Neurol 2022; 128:1-8. [PMID: 34992035 PMCID: PMC9685598 DOI: 10.1016/j.pediatrneurol.2021.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/09/2021] [Revised: 11/28/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND It is not known whether brain magnetic resonance imaging (MRI) abnormalities in pediatric sepsis are associated with clinical outcomes. Study objectives were to (1) determine the prevalence and type of sepsis-related neuroimaging abnormalities evident on clinically indicated brain MRI in children with sepsis and (2) test the association of these abnormalities with mortality, new disability, length of stay (LOS), and MRI indication. METHODS Retrospective cohort study of 140 pediatric patients with sepsis and a clinically indicated brain MRI obtained within 60 days of sepsis onset at a single, large academic pediatric intensive care unit (PICU). Two radiologists systematically reviewed the first post-sepsis brain MRI and determined which abnormalities were sepsis-related. Outcomes compared in patients with versus without sepsis-related MRI abnormalities. RESULTS PICU mortality was 7%. Thirty patients had one or more sepsis-related MRI abnormality, yielding a prevalence of 21% (95% confidence interval 15%, 28%). Among those, 53% (16 of 30) had sepsis-related white matter signal abnormalities; 53% (16 of 30) sepsis-related ischemia, infarction, or thrombosis; and 27% (eight of 30) sepsis-related posterior reversible encephalopathy. Patients with one or more sepsis-related MRI abnormality had increased mortality (17% vs 5%; P = 0.04), new neurological disability at PICU discharge (32% vs 11%; P = 0.03), and longer PICU LOS (median 18 vs 11 days; P = 0.04) compared with patients without. CONCLUSIONS In children with sepsis and a clinically indicated brain MRI, 21% had a sepsis-related MRI abnormality. Sepsis-related MRI abnormalities were associated with increased mortality, new neurological disability, and longer PICU LOS.
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Affiliation(s)
- Andrew E. Becker
- Department of Anesthesiology & Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sara R. Teixeira
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Nicholas A. Lunig
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Antara Mondal
- Department of Biomedical & Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Julie C. Fitzgerald
- Department of Anesthesiology & Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA,CHOP Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Alexis A. Topjian
- Department of Anesthesiology & Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Scott L. Weiss
- Department of Anesthesiology & Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA,CHOP Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Heather Griffis
- Department of Biomedical & Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Stephanie E. Schramm
- Department of Anesthesiology & Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Danielle M. Traynor
- Department of Anesthesiology & Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Arastoo Vossough
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Matthew P. Kirschen
- Department of Anesthesiology & Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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18
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Sukhavasi A, McHugh-Grant S, Glatz AC, Mondal A, Griffis H, Burnham N, Chen JM, Mascio CE, Gaynor JW, Spray TL, Fuller SM. Pulmonary Atresia with Intact Ventricular Septum: Intended Strategies. J Thorac Cardiovasc Surg 2022; 164:1277-1288. [DOI: 10.1016/j.jtcvs.2021.11.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/06/2021] [Accepted: 11/24/2021] [Indexed: 10/31/2022]
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19
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Weinreb SJ, Okunowo O, Griffis H, Vetter V. Incidence of Morbidity and Mortality in a Cohort of Congenital Complete Heart Block Patients Followed Over 40 Years. Heart Rhythm 2022; 19:1149-1155. [PMID: 35217197 DOI: 10.1016/j.hrthm.2022.02.019] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Congenital Complete Heart Block (CCHB), seen in 1:15,000-20,000 births, commonly requires pacemaker placement by young adulthood. There is limited understanding of cardiac morbidity and mortality. OBJECTIVE Determine long-term incidence of cardiac morbidity and mortality in subjects with CCHB and identify associated risk factors. METHODS Retrospective cohort analysis of subjects with CCHB at Children's Hospital of Philadelphia between 1976-2018. The primary outcome is a composite of death, left ventricular systolic dysfunction, heart failure, cardiomyopathy, or cardiac resynchronization therapy (CRT). Cox proportional hazard models assessed independent risk factors for the primary outcome and its components (death, heart failure and/or cardiomyopathy, CRT). RESULTS One-hundred-fourteen subjects (58% female, median age at last visit 15.2 years) were included. Eighty-eight (77%) underwent pacemaker implantation, with median age at placement 1.9 years (IQR, 0.1-8.0 years). Twenty-six subjects (23%) reached the primary outcome - 7 (6%) died and 14 (12%) were diagnosed with heart failure and/or cardiomyopathy. Median time from diagnosis to primary outcome was 3.1 years (IQR, 0.0-10.8 years). There were no significant associations between age at diagnosis less than 1-year (hazard ratio [HR]: 1.5, 95% CI 0.6-3.9), fetal diagnosis (HR: 2.3, 0.96-5.6), or maternal antibody positivity (HR: 2.4, 0.9-6.6) and the primary outcome. Fetal diagnosis had a higher associated hazard of heart failure and/or cardiomyopathy (HR: 4.5, 1.3-15.0). CONCLUSION In 114 subjects with CCHB, 23% reached the composite outcome of cardiac morbidity and mortality, with no significant association between age at diagnosis, fetal diagnosis, and maternal antibody status with composite cardiac morbidity and mortality.
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Affiliation(s)
- Scott J Weinreb
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19146.
| | - Oluwatimilehin Okunowo
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19146
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19146
| | - Victoria Vetter
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19146; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19146
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20
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Edelson JB, Edwards JJ, Katcoff H, Mondal A, Chen F, Reza N, Hanff TC, Griffis H, Mazurek JA, Wald J, Burstein DS, Atluri P, O'Connor MJ, Goldberg LR, Zamani P, Groeneveld PW, Rossano JW, Lin KY, Birati EY. Novel Risk Model to Predict Emergency Department Associated Mortality for Patients Supported With a Ventricular Assist Device: The Emergency Department-Ventricular Assist Device Risk Score. J Am Heart Assoc 2022; 11:e020942. [PMID: 35023355 PMCID: PMC9238533 DOI: 10.1161/jaha.121.020942] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The past decade has seen tremendous growth in patients with ambulatory ventricular assist devices. We sought to identify patients that present to the emergency department (ED) at the highest risk of death. Methods and Results This retrospective analysis of ED encounters from the Nationwide Emergency Department Sample includes 2010 to 2017. Using a random sampling of patient encounters, 80% were assigned to development and 20% to validation cohorts. A risk model was derived from independent predictors of mortality. Each patient encounter was assigned to 1 of 3 groups based on risk score. A total of 44 042 ED ventricular assist device patient encounters were included. The majority of patients were male (73.6%), <65 years old (60.1%), and 29% presented with bleeding, stroke, or device complication. Independent predictors of mortality during the ED visit or subsequent admission included age ≥65 years (odds ratio [OR], 1.8; 95% CI, 1.3-4.6), primary diagnoses (stroke [OR, 19.4; 95% CI, 13.1-28.8], device complication [OR, 10.1; 95% CI, 6.5-16.7], cardiac [OR, 4.0; 95% CI, 2.7-6.1], infection [OR, 5.8; 95% CI, 3.5-8.9]), and blood transfusion (OR, 2.6; 95% CI, 1.8-4.0), whereas history of hypertension was protective (OR, 0.69; 95% CI, 0.5-0.9). The risk score predicted mortality areas under the curve of 0.78 and 0.71 for development and validation. Encounters in the highest risk score strata had a 16-fold higher mortality compared with the lowest risk group (15.8% versus 1.0%). Conclusions We present a novel risk score and its validation for predicting mortality of patients with ED ventricular assist devices, a high-risk, and growing, population.
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Affiliation(s)
- Jonathan B Edelson
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA.,Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,Leonard Davis Institute for Healthcare EconomicsUniversity of Pennsylvania Philadelphia PA
| | - Jonathan J Edwards
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA
| | - Hannah Katcoff
- Data Science and Biostatistics Unit Department of Biomedical and Health Informatics The Children's Hospital of Philadelphia Philadelphia PA
| | - Antara Mondal
- Data Science and Biostatistics Unit Department of Biomedical and Health Informatics The Children's Hospital of Philadelphia Philadelphia PA
| | - Feiyan Chen
- Data Science and Biostatistics Unit Department of Biomedical and Health Informatics The Children's Hospital of Philadelphia Philadelphia PA
| | - Nosheen Reza
- Cardiovascular Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Thomas C Hanff
- Cardiovascular Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Heather Griffis
- Leonard Davis Institute for Healthcare EconomicsUniversity of Pennsylvania Philadelphia PA
| | - Jeremy A Mazurek
- Cardiovascular Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Joyce Wald
- Cardiovascular Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Danielle S Burstein
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA
| | - Pavan Atluri
- Cardiothoracic Surgery Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Matthew J O'Connor
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA
| | - Lee R Goldberg
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,Cardiovascular Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Payman Zamani
- Cardiovascular Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Peter W Groeneveld
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,General Internal Medicine Division Department of Medicine Perelman School of MedicineUniversity of Pennsylvania Philadelphia PA
| | - Joseph W Rossano
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA.,Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA
| | - Kimberly Y Lin
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaPerelman School of MedicineUniversity of Pennsylvania Philadelphia PA
| | - Edo Y Birati
- Cardiovascular Outcomes, Quality, and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,Cardiothoracic Surgery Perelman School of Medicine University of Pennsylvania Philadelphia PA.,The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine and Surgery Padeh-Poriya Medical CenterBar Ilan University Israel
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21
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Kaplinski M, Griffis H, Liu F, Tinker C, Laney NC, Mendoza M, Cohen MS, Meyers K, Natarajan SS. Left Ventricular Measurements and Strain in Pediatric Patients Evaluated for Systemic Hypertension and the Effect of Adequate Anti-hypertensive Treatment. Pediatr Cardiol 2022; 43:155-163. [PMID: 34426850 DOI: 10.1007/s00246-021-02706-x] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/08/2021] [Indexed: 11/24/2022]
Abstract
Pediatric hypertension (HTN) is an epidemic that is associated with HTN in adulthood and adverse cardiovascular outcomes. We hypothesized that children with HTN would have left ventricular (LV) hypertrophy and abnormal LV global longitudinal strain (GLS) on echocardiogram and that these values would differ by weight, race, and HTN treatment. Data were collected from first visits to the HTN Program from 12/2011 to 9/2018, excluding patients with cardiac disease or heart transplantation. LV measurements including LV mass index (LVMI), LV GLS, and diastolic indices were compared between groups. Multivariable logistic regression was used to identify risk factors for an abnormal LVMI. There were 212 patients with an interquartile age range of 13-18 years. On univariate analysis, LVMI was higher in hypertensive, obese, and African American patients. LV strain was less negative in obese and African American patients. Adequately treated patients with HTN had a higher LVMI and a higher E/e' ratio compared to patients with no HTN. On multivariate analysis, only obesity was associated with an LVMI ≥ 95th percentile (OR 2.9, 95% CI 1.4, 5.8). LVMI is higher in hypertensive, obese, and African American patients; however, in the multivariate analysis, obesity was the only independent risk factor for an abnormal LVMI. LVMI was still higher in those adequately treated for HTN compared to patients without HTN, possibly due to concomitant obesity. Future studies should focus on subclinical changes in LV performance seen in obese and hypertensive patients and the impact on long-term health.
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Affiliation(s)
- Michelle Kaplinski
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Suite 325, Palo Alto, CA, 94340, USA.
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Fang Liu
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Craig Tinker
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Nina C Laney
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Melodee Mendoza
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Meryl S Cohen
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Meyers
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Shobha S Natarajan
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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22
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Lang SS, Kilbaugh T, Friess S, Sotardi S, Kim CT, Mazandi V, Zhang B, Storm PB, Heuer GG, Tucker A, Ampah SB, Griffis H, Raghupathi R, Huh JW. Trajectory of Long-Term Outcome in Severe Pediatric Diffuse Axonal Injury: An Exploratory Study. Front Neurol 2021; 12:704576. [PMID: 34594294 PMCID: PMC8477000 DOI: 10.3389/fneur.2021.704576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: Pediatric severe traumatic brain injury (TBI) is one of the leading causes of disability and death. One of the classic pathoanatomic brain injury lesions following severe pediatric TBI is diffuse (multifocal) axonal injury (DAI). In this single institution study, our overarching goal was to describe the clinical characteristics and long-term outcome trajectory of severe pediatric TBI patients with DAI. Methods: Pediatric patients (<18 years of age) with severe TBI who had DAI were retrospectively reviewed. We evaluated the effect of age, sex, Glasgow Coma Scale (GCS) score, early fever ≥ 38.5°C during the first day post-injury, the extent of ICP-directed therapy needed with the Pediatric Intensity Level of Therapy (PILOT) score, and MRI within the first week following trauma and analyzed their association with outcome using the Glasgow Outcome Score—Extended (GOS-E) scale at discharge, 6 months, 1, 5, and 10 years following injury. Results: Fifty-six pediatric patients with severe traumatic DAI were analyzed. The majority of the patients were >5 years of age and male. There were 2 mortalities. At discharge, 56% (30/54) of the surviving patients had unfavorable outcome. Sixty five percent (35/54) of surviving children were followed up to 10 years post-injury, and 71% (25/35) of them made a favorable recovery. Early fever and extensive DAI on MRI were associated with worse long-term outcomes. Conclusion: We describe the long-term trajectory outcome of severe pediatric TBI patients with pure DAI. While this was a single institution study with a small sample size, the majority of the children survived. Over one-third of our surviving children were lost to follow-up. Of the surviving children who had follow-up for 10 years after injury, the majority of these children made a favorable recovery.
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Affiliation(s)
- Shih-Shan Lang
- Division of Neurosurgery, Department of Neurosurgery, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Todd Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Stuart Friess
- Department of Pediatrics, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Susan Sotardi
- Department of Radiology and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Chong Tae Kim
- Department of Physical Medicine and Rehabilitation and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Vanessa Mazandi
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Bingqing Zhang
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Phillip B Storm
- Division of Neurosurgery, Department of Neurosurgery, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Gregory G Heuer
- Division of Neurosurgery, Department of Neurosurgery, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Alexander Tucker
- Division of Neurosurgery, Department of Neurosurgery, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Steve B Ampah
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Ramesh Raghupathi
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Jimmy W Huh
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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23
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Edwards JJ, Edelson JB, Katcoff H, Mondal A, Lefkowitz D, Reza N, Hanff TC, Griffis H, Mazurek JA, Wald J, Owens AT, Wittlieb-Weber CA, Burstein DS, Atluri P, O'Connor MJ, Goldberg LR, Zamani P, Groeneveld PW, Rossano JW, Lin KY, Birati EY. Mental health disorders and emergency resource use and outcomes in ventricular assist device supported patients. Am Heart J 2021; 240:11-15. [PMID: 34089695 PMCID: PMC8484029 DOI: 10.1016/j.ahj.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/05/2021] [Accepted: 05/28/2021] [Indexed: 11/20/2022]
Abstract
There are limited data describing the prevalence of mental health disorders (MHDOs) in patients with ventricular assist devices (VADs), or associations between MHDOs and resource use or outcomes. We used the Nationwide Emergency Department Sample administrative database to analyze 44,041 ED encounters for VAD-supported adults from 2010 to 2017, to assess the relationship between MHDOs and outcomes in this population. MHDO diagnoses were present for 23% of encounters, and were associated with higher charges and rates of admission, but lower mortality.
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Affiliation(s)
- Jonathan J Edwards
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA.
| | - Jonathan B Edelson
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Pennsylvania, PA; Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Pennsylvania , PA
| | - Hannah Katcoff
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit the Children's Hospital of Philadelphia, Pennsylvania, PA
| | - Antara Mondal
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit the Children's Hospital of Philadelphia, Pennsylvania, PA
| | - Debra Lefkowitz
- Department of Child and Adolescent Psychiatry and avioral Sciences, the Children's Hospital of Philadelphia, Pennsylvania, PA
| | - Nosheen Reza
- Department of Medicine, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA
| | - Thomas C Hanff
- Department of Medicine, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA
| | - Heather Griffis
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit the Children's Hospital of Philadelphia, Pennsylvania, PA
| | - Jeremy A Mazurek
- Department of Medicine, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA
| | - Joyce Wald
- Department of Medicine, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA
| | - Anjali T Owens
- Department of Medicine, Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA
| | - Carol A Wittlieb-Weber
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA
| | - Danielle S Burstein
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA
| | - Pavan Atluri
- Cardiothoracic Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania , PA
| | - Matthew J O'Connor
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA
| | - Lee R Goldberg
- Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Pennsylvania, PA; Department of Medicine, General Internal Medicine Division, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA
| | - Payman Zamani
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit the Children's Hospital of Philadelphia, Pennsylvania, PA
| | - Peter W Groeneveld
- Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Pennsylvania, PA; Cardiothoracic Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania , PA
| | - Joseph W Rossano
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Pennsylvania, PA
| | - Kimberly Y Lin
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA
| | - Edo Y Birati
- Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Pennsylvania, PA; Department of Medicine, General Internal Medicine Division, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA; Cardiovascular Division, Poriya Medical Center, Bar-Ilan University, Israel
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24
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Guevara JP, Power TJ, Bevans K, Snitzer L, Leavy S, Stewart D, Broomfield C, Shah S, Grundmeier R, Michel JJ, Berkowitz S, Blum NJ, Bryan M, Griffis H, Fiks AG. Improving Care Management in Attention-Deficit/Hyperactivity Disorder: An RCT. Pediatrics 2021; 148:peds.2020-031518. [PMID: 34281997 DOI: 10.1542/peds.2020-031518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/12/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare the effectiveness of care management combined with a patient portal versus a portal alone for communication among children with attention-deficit/hyperactivity disorder (ADHD). METHODS Randomized controlled trial conducted at 11 primary care practices. Children aged 5 to 12 years old with ADHD were randomly assigned to care management + portal or portal alone. The portal included parent-reported treatment preferences and goals, medication side effects, and parent- and teacher-reported ADHD symptom scales. Care managers provided education to families; communicated quarterly with parents, teachers, and clinicians; and coordinated care. The main outcome, changes in the Vanderbilt Parent Rating Scale (VPRS) score as a measure of ADHD symptoms, was assessed using intention-to-treat analysis. RESULTS A total of 303 eligible children (69% male; 46% Black) were randomly assigned, and 273 (90%) completed the study. During the 9-month study, parents in the care management + portal arm communicated inconsistently with care managers (mean 2.2; range 0-6) but similarly used the portal (mean 2.3 vs 2.2) as parents in the portal alone arm. In multivariate models, VPRS scores decreased over time (Adjusted β = -.015; 95% confidence interval -0.023 to -0.07) in both groups, but there were no intervention-by-time effects (Adjusted β = .000; 95% confidence interval -0.011 to 0.012) between groups. Children who received ≥2 care management sessions had greater reductions in VPRS scores than those with fewer sessions. CONCLUSIONS Results did not provide evidence that care management combined with a patient portal was different from portal use alone among children with ADHD. Both groups demonstrated similar reductions in ADHD symptoms. Those families with greater care management engagement demonstrated greater reductions than those with less engagement.
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Affiliation(s)
| | - Thomas J Power
- Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine Bevans
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Lisa Snitzer
- Mental Health Partnerships, Philadelphia, Pennsylvania
| | | | - Denise Stewart
- City of Philadelphia Water Department, Philadelphia, Pennsylvania
| | | | | | | | | | - Steven Berkowitz
- Department of Psychiatry, University of Colorado, Denver, Colorado
| | | | - Matthew Bryan
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather Griffis
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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25
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Edelson JB, Huang Y, Griffis H, Huang J, Mascio CE, Chen JM, Maeda K, Burstein DS, Wittlieb-Weber C, Lin KY, O'Connor MJ, Rossano JW. The influence of mechanical Circulatory support on post-transplant outcomes in pediatric patients: A multicenter study from the International Society for Heart and Lung Transplantation (ISHLT) Registry. J Heart Lung Transplant 2021; 40:1443-1453. [PMID: 34253457 DOI: 10.1016/j.healun.2021.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/12/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Mechanical circulatory support (MCS) is increasingly being used as a bridge to transplant in pediatric patients. We compare outcomes in pediatric patients bridged to transplant with MCS from an international cohort. METHODS This retrospective cohort study of heart-transplant patients reported to the International Society for Heart and Lung Transplantation (ISHLT) registry from 2005-2017 includes 5,095 patients <18 years. Pretransplant MCS exposure and anatomic diagnosis were derived. Outcomes included mortality, renal failure, and stroke. RESULTS 26% of patients received MCS prior to transplant: 240 (4.7%) on extracorporeal membrane oxygenation (ECMO), 1,030 (20.2%) on ventricular assist device (VAD), and 54 (1%) both. 29% of patients were <1 year, and 43.8% had congenital heart disease (CHD). After adjusting for clinical characteristics, compared to no-MCS and VAD, ECMO had higher mortality during their transplant hospitalization [OR 3.97 & 2.55; 95% CI 2.43-6.49 & 1.42-4.60] while VAD mortality was similar [OR 1.55; CI 0.99-2.45]. Outcomes of ECMO+VAD were similar to ECMO alone, including increased mortality during transplant hospitalization compared to no-MCS [OR 4.74; CI 1.81-12.36]. Patients with CHD on ECMO had increased 1 year, and 10 year mortality [HR 2.36; CI 1.65-3.39], [HR 1.82; CI 1.33-2.49]; there was no difference in survival in dilated cardiomyopathy (DCM) patients based on pretransplant MCS status. CONCLUSION Survival in CHD and DCM is similar in patients with no MCS or VAD prior to transplant, while pretransplant ECMO use is strongly associated with mortality after transplant particularly in children with CHD. In children with DCM, long term survival was equivalent regardless of MCS status.
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Affiliation(s)
- J B Edelson
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Y Huang
- Department of Biomedical Health Informatics, Data Science and Biostatistics Unit, the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - H Griffis
- Department of Biomedical Health Informatics, Data Science and Biostatistics Unit, the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - J Huang
- Department of Biomedical Health Informatics, Data Science and Biostatistics Unit, the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - C E Mascio
- Division of Cardiothoracic Surgery, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - J M Chen
- Division of Cardiothoracic Surgery, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - K Maeda
- Division of Cardiothoracic Surgery, Cardiac Center, the Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - D S Burstein
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - C Wittlieb-Weber
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - K Y Lin
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - M J O'Connor
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J W Rossano
- Division of Cardiology, Cardiac Center, the Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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26
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Raymond TT, Pandit SV, Griffis H, Zhang X, Hanna R, Niles DE, Silver A, Lasa JJ, Haskell SE, Atkins DL, Nadkarni VM. Effect of Amplitude Spectral Area on Termination of Fibrillation and Outcomes in Pediatric Cardiac Arrest. J Am Heart Assoc 2021; 10:e020353. [PMID: 34096341 PMCID: PMC8477851 DOI: 10.1161/jaha.120.020353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Amplitude spectral area (AMSA) predicts termination of fibrillation (TOF) with return of spontaneous circulation (ROSC) and survival in adults but has not been studied in pediatric cardiac arrest. We characterized AMSA during pediatric cardiac arrest from a Pediatric Resuscitation Quality Collaborative and hypothesized that AMSA would be associated with TOF and ROSC. Methods and Results Children aged <18 years with cardiac arrest and ventricular fibrillation were studied. AMSA was calculated for 2 seconds before shock and averaged for each subject (AMSA‐avg). TOF was defined as termination of ventricular fibrillation 10 seconds after defibrillation to any non‐ventricular fibrillation rhythm. ROSC was defined as >20 minutes without chest compressions. Univariate and multivariable logistic regression analyses controlling for weight, current, and illness category were performed. Primary end points were TOF and ROSC. Secondary end points were 24‐hour survival and survival to discharge. Between 2015 and 2019, 50 children from 14 hospitals with 111 shocks were identified. In univariate analyses AMSA was not associated with TOF and AMS‐Aavg was not associated with ROSC. Multivariable logistic regression showed no association between AMSA and TOF but controlling for defibrillation average current and illness category, there was a trend to significant association between AMSA‐avg and ROSC (odds ratio, 1.10 [1.00‒1.22] P=0.058). There was no significant association between AMSA‐avg and 24‐hour survival or survival to hospital discharge. Conclusions In pediatric patients, AMSA was not associated with TOF, whereas AMSA‐avg had a trend to significance for association in ROSC, but not 24‐hour survival or survival to hospital discharge. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02708134.
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Affiliation(s)
- Tia T Raymond
- Division of Cardiac Critical Care Department of Pediatrics Medical City Children's Hospital Dallas TX
| | | | - Heather Griffis
- Data Science and Biostatistics Unit Department of Biomedical and Health Informatics The Children's Hospital of Philadelphia PA
| | - Xuemei Zhang
- Data Science and Biostatistics Unit Department of Biomedical and Health Informatics The Children's Hospital of Philadelphia PA
| | - Richard Hanna
- Data Science and Biostatistics Unit Department of Biomedical and Health Informatics The Children's Hospital of Philadelphia PA
| | - Dana E Niles
- Department of Anesthesiology and Critical Care, and The Center for Simulation, Advanced Education, and Innovation The Children's Hospital of Philadelphia Philadelphia PA
| | | | - Javier J Lasa
- Sections of Cardiology and Critical Care Department of Pediatrics Texas Children's Hospital Houston TX
| | - Sarah E Haskell
- Division of Pediatric Cardiology Stead Family Department of Pediatrics University of Iowa Stead Family Children's Hospital Iowa City IA
| | - Dianne L Atkins
- Division of Pediatric Cardiology Stead Family Department of Pediatrics University of Iowa Stead Family Children's Hospital Iowa City IA
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care, and The Center for Simulation, Advanced Education, and Innovation The Children's Hospital of Philadelphia Philadelphia PA.,Department of Anesthesiology, Critical Care, and Pediatrics The Children's Hospital of PhiladelphiaUniversity of Pennsylvania Philadelphia PA
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27
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Mejia E, Lynch A, Hearle P, Okunowo O, Griffis H, Shah M, Lynch D, Lin KY. Ectopic Burden via Holter Monitors in Friedreich Ataxia. Pediatr Neurol 2021; 117:29-33. [PMID: 33652339 PMCID: PMC8085807 DOI: 10.1016/j.pediatrneurol.2021.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/05/2020] [Revised: 01/09/2021] [Accepted: 01/17/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Friedreich ataxia is the most commonly inherited ataxia; nearly 60% of deaths are cardiac in nature, with one in eight deaths due to arrhythmia. Additional or irregular heartbeats, measured as ectopy, can be quantified using portable heart rhythm monitoring. We sought to describe the ectopic burden in Friedreich ataxia. METHODS Using a natural history study of patients with Friedreich ataxia at a single center, we analyzed portable heart rhythm monitors (Holters). Ectopic burden was defined as the proportion of atrial or ventricular ectopic beats over total beats. RESULTS Of 456 patients, 131 had Holters. Sixty-eight (52.0%) were male, median age of symptom onset was 8.0 years (5.0 to 13.0, n = 111), median age at time of Holter was 17.3 years (interquartile range [IQR] 12.9 to 22.8, n = 129), and median duration of illness was 8.7 years (IQR 5.3 to 11.6, n = 110). Median GAA length on the shorter FXN allele was 706.0 (IQR 550.0 to 840.0, n = 112). Eight (7.8%, n = 103) had diminished cardiac function, and 74 (74.0%, n = 100) had ventricular hypertrophy. Ninety patients (83.0%) had atrial ectopy (supraventricular ectopy [SVE]): 85 (78.0%) with rare SVE (>0% to 5%) and five (5.0%) with frequent SVE (>10%). Twenty-five (19.0%) had supraventricular runs, and one (0.8%) had atrial fibrillation/flutter. Forty-five (41.0%) had ventricular ectopy (VE): 43 (39.0%) with rare VE (0% to 5%) and two (2.0%) with moderate VE (5% to 10%). Compared with patients with none and rare SVE, patients with frequent SVE had longer disease duration (18.3 versus 4.6 versus 9.0 years, P = 0.0005). CONCLUSION Patients with longer disease duration had higher rates of SVE. Heart rhythm monitoring may be considered for risk stratification; however, longitudinal analysis is needed.
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Affiliation(s)
- Erika Mejia
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Abigail Lynch
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patrick Hearle
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Oluwatimilehin Okunowo
- Data Science & Biostatistics Unit, Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather Griffis
- Data Science & Biostatistics Unit, Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maully Shah
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David Lynch
- Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kimberly Y. Lin
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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28
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Burstein DS, Griffis H, Zhang X, Cantor RS, Dai D, Shamszad P, Huang YS, Morales DLS, Hall M, Lin KY, O'Connor MJ, Zinn M, Edens RE, Parrino PE, Kirklin JK, Rossano JW. Resource utilization in children with paracorporeal continuous-flow ventricular assist devices. J Heart Lung Transplant 2021; 40:478-487. [PMID: 33744087 DOI: 10.1016/j.healun.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Paracorporeal continuous-flow ventricular assist devices (PCF VAD) are increasingly used in pediatrics, yet PCF VAD resource utilization has not been reported to date. METHODS Pediatric Interagency Registry for Mechanically Assisted Circulatory Support (PediMACS), a national registry of VADs in children, and Pediatric Health Information System (PHIS), an administrative database of children's hospitals, were merged to assess VAD implants from 19 centers between 2012 and 2016. Resource utilization, including hospital and intensive care unit length of stay (LOS), and costs are analyzed for PCF VAD, durable VAD (DVAD), and combined PCF-DVAD support. RESULTS Of 177 children (20% PCF VAD, 14% PCF-DVAD, 66% DVAD), those with PCF VAD or PCF-DVAD are younger (median age 4 [IQR 0-10] years and 3 [IQR 0-9] years, respectively) and more often have congenital heart disease (44%; 28%, respectively) compared to DVAD (11 [IQR 3-17] years; 14% CHD); p < 0.01 for both. Median post-VAD LOS is prolonged ranging from 43 (IQR 15-82) days in PCF VAD to 72 (IQR 55-107) days in PCF-DVAD, with significant hospitalization costs (PCF VAD $450,000 [IQR $210,000-$780,000]; PCF-DVAD $770,000 [IQR $510,000-$1,000,000]). After adjusting for patient-level factors, greater post-VAD hospital costs are associated with LOS, ECMO pre-VAD, greater chronic complex conditions, and major adverse events (p < 0.05 for all). VAD strategy and underlying cardiac disease are not associated with LOS or overall costs, although PCF VAD is associated with higher daily-level costs driven by increased pharmacy, laboratory, imaging, and clinical services costs. CONCLUSION Pediatric PCF VAD resource utilization is staggeringly high with costs primarily driven by pre-implantation patient illness, hospital LOS, and clinical care costs.
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Affiliation(s)
- Danielle S Burstein
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Heather Griffis
- Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Xuemei Zhang
- Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dingwei Dai
- Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pirouz Shamszad
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yuan-Shung Huang
- Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David L S Morales
- Division of Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Kimberly Y Lin
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew J O'Connor
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew Zinn
- Division of Cardiology, The University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - R Erik Edens
- Department of Pediatrics, Children's Minnesota, Minneapolis, Minnesota
| | - P Eugene Parrino
- Division of Cardiothoracic Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - James K Kirklin
- Division of Cardiothoracic Surgery, Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Joseph W Rossano
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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29
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Edelson JB, Rossano JW, Griffis H, Quarshie WO, Ravishankar C, O'Connor MJ, Mascio CE, Mercer-Rosa L, Glatz AC, Lin KY. Resource Use and Outcomes of Pediatric Congenital Heart Disease Admissions: 2003 to 2016. J Am Heart Assoc 2021; 10:e018286. [PMID: 33554612 PMCID: PMC7955343 DOI: 10.1161/jaha.120.018286] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Children with congenital heart disease (CHD) are known to consume a disproportionate share of resources, yet there are limited data concerning trends in resource use and mortality among admitted children with CHD. We hypothesize that charges in CHD‐related admissions increased but that mortality improved over time. Methods and Results This study, including patients <18 years old with CHD, examined inpatient admissions from the nationally representative Kids' Inpatient Database from 2003 to 2016 in order to assess the frequency, medical complexity, and outcomes of CHD hospital admissions. A total of 859 843 admissions of children with CHD were identified. CHD admissions increased by 31.8% from 2003 to 2016, whereas overall pediatric admissions decreased by 13.4%. Compared with non‐CHD admissions, those with CHD were more likely to be <1 year of age (80.5% versus 63.3%), and to have ≥1 complex chronic condition (39.7% versus 9.3%). For CHD admissions, mortality was higher (2.97% versus 0.31%) and adjusted median charges greater ($48 426 [interquartile range (IQR), $11.932–$161 048] versus $4697 [IQR, $2551–$12 301]) (P<0.0001 for all). Among CHD admissions, whereas adjusted median charges increased from $35 577 (IQR, $9303–$110 439) to $61 696 (IQR, $15 212–$219 237), mortality decreased from 3.2% to 2.7% (P for trend <0.0001). CHD admissions accounted for an increased proportion of all inpatient deaths, from 18.0% in 2003 to 24.5% in 2016. Conclusions Children admitted with CHD are 10 times more likely to die than those without CHD and have higher charges. Although the rate of mortality in CHD admissions decreased, children with CHD accounted for an increasing proportion of all pediatric inpatient deaths. Effective resource allocation is critical to optimize outcomes in these high‐risk patients.
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Affiliation(s)
- Jonathan B Edelson
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA.,Cardiovascular OutcomesQuality and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health EconomicsUniversity of Pennsylvania Philadelphia PA
| | - Joseph W Rossano
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA.,Cardiovascular OutcomesQuality and Evaluative Research CenterUniversity of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health EconomicsUniversity of Pennsylvania Philadelphia PA
| | - Heather Griffis
- Department of Biomedical Health Informatics Healthcare Analytics Unitthe Children's Hospital of Philadelphia PA
| | - William O Quarshie
- Department of Biomedical Health Informatics Healthcare Analytics Unitthe Children's Hospital of Philadelphia PA
| | - Chitra Ravishankar
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Matthew J O'Connor
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Christopher E Mascio
- Division of Cardiothoracic Surgery Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Laura Mercer-Rosa
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Andrew C Glatz
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Kimberly Y Lin
- Division of Cardiology Cardiac Center, the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
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Edelson JB, Edwards JJ, Katcoff H, Mondal A, Reza N, Hanff TC, Griffis H, Mazurek JA, Wald J, Owens AT, Burstein DS, Atluri P, O'Connor MJ, Goldberg LR, Zamani P, Groeneveld PW, Rossano JW, Lin KY, Birati EY. An Increasing Burden of Disease: Emergency Department Visits Among Patients With Ventricular Assist Devices From 2010 to 2017. J Am Heart Assoc 2021; 10:e018035. [PMID: 33543642 PMCID: PMC7955344 DOI: 10.1161/jaha.120.018035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background With a growing population of patients supported by ventricular assist devices (VADs) and the improvement in survival of this patient population, understanding the healthcare system burden is critical to improving outcomes. Thus, we sought to examine national estimates of VAD-related emergency department (ED) visits and characterize their demographic, clinical, and outcomes profile. Additionally, we tested the hypotheses that resource use increased and mortality improved over time. Methods and Results This retrospective database analysis uses encounter-level data from the 2010 to 2017 Nationwide Emergency Department Sample. The primary outcome was mortality. From 2010 to 2017, >880 million ED visits were evaluated, with 44 042 VAD-related ED visits identified. The annual mean visits were 5505 (SD 4258), but increased 16-fold from 2010 to 2017 (824 versus 13 155). VAD-related ED visits frequently resulted in admission (72%) and/or death (3.0%). Median inflation-adjusted charges were $25 679 (interquartile range, $7450, $63 119) per encounter. The most common primary diagnoses were cardiac (22%), and almost 30% of encounters were because of bleeding, stroke, or device complications. From 2010 to 2017, admission and mortality decreased from 82% to 71% and 3.4% to 2.4%, respectively (P for trends <0.001, both). Conclusions We present the first study using national-level data to characterize the growing ED resource use and financial burden of patients supported by VAD. During the past decade, admission and mortality rates decreased but remain substantial; in 2017 ≈1 in every 40 VAD ED encounters resulted in death, making it critical that clinical decision-making be optimized for patients with VAD to maximize good outcomes.
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Affiliation(s)
- Jonathan B Edelson
- Division of Cardiology Cardiac Center the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA.,Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | - Jonathan J Edwards
- Division of Cardiology Cardiac Center the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Hannah Katcoff
- Department of Biomedical Health Informatics, Healthcare Analytics Unit the Children's Hospital of Philadelphia Philadelphia PA
| | - Antara Mondal
- Department of Biomedical Health Informatics, Healthcare Analytics Unit the Children's Hospital of Philadelphia Philadelphia PA
| | - Nosheen Reza
- Cardiovascular Division Department of Medicine Perelman School of Medicine Philadelphia PA
| | - Thomas C Hanff
- Cardiovascular Division Department of Medicine Perelman School of Medicine Philadelphia PA
| | - Heather Griffis
- Department of Biomedical Health Informatics, Healthcare Analytics Unit the Children's Hospital of Philadelphia Philadelphia PA
| | - Jeremy A Mazurek
- Cardiovascular Division Department of Medicine Perelman School of Medicine Philadelphia PA
| | - Joyce Wald
- Cardiovascular Division Department of Medicine Perelman School of Medicine Philadelphia PA
| | - Anjali T Owens
- Cardiovascular Division Department of Medicine Perelman School of Medicine Philadelphia PA
| | - Danielle S Burstein
- Division of Cardiology Cardiac Center the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Pavan Atluri
- Department of Biomedical Health Informatics, Healthcare Analytics Unit the Children's Hospital of Philadelphia Philadelphia PA
| | - Matthew J O'Connor
- Division of Cardiology Cardiac Center the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Lee R Goldberg
- Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Cardiovascular Division Department of Medicine Perelman School of Medicine Philadelphia PA
| | - Payman Zamani
- Cardiothoracic Surgery Perelman School of Medicine Philadelphia PA
| | - Peter W Groeneveld
- Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,General Internal Medicine Division Department of Medicine Perelman School of Medicine Philadelphia PA
| | - Joseph W Rossano
- Division of Cardiology Cardiac Center the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA.,Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA
| | - Kimberly Y Lin
- Division of Cardiology Cardiac Center the Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Edo Y Birati
- Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Cardiovascular Division Department of Medicine Perelman School of Medicine Philadelphia PA.,Cardiovascular Division Poriya Medical CenterBar Ilan University Ramat Gan Israel
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Burstein DS, Rossano JW, Griffis H, Zhang X, Fowler R, Frischertz B, Kim YY, Lindenfield J, Mazurek JA, Edelson JB, Menachem JN. Greater admissions, mortality and cost of heart failure in adults with congenital heart disease. Heart 2020; 107:807-813. [PMID: 33361349 DOI: 10.1136/heartjnl-2020-318246] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 09/15/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Limited contemporary data exist regarding outcomes and resource use among adults with congenital heart disease and heart failure (ACHD-HF). This study compared outcomes, emergency department (ED) and hospital resource use, and advanced heart failure (HF) therapies in ACHD-HF versus non-ACHD with HF (HF-non-ACHD). METHODS The Nationwide Emergency Department Sample and Nationwide Inpatient Sample were used to analyse outcomes and resource use among ACHD-HF ED visits and hospitalisations from 2006 to 2016. ACHD-HF was stratified by single-ventricle (SV) and two-ventricle (2V) disease. RESULTS A total of 76 557 ACHD-HF visits (3.6% SV physiology) and 31 137 414 HF-non-ACHD visits were analysed. ACHD-HFs were younger (SV 33 years (IQR 25-44), 2V 62 years (IQR 45-76); HF-non-ACHD 74 years (IQR 63-83); p<0.001). ACHD-HFs had higher ED admissions (78% vs 70%, p<0.001), longer hospital length of stay (5 days (IQR 2-8) vs 4 days (IQR 2-7), p<0.001) and greater hospital costs ($49K (IQR 2K-121K) vs $32K (17K-66K), p<0.001). Mortality was significantly higher among ACHD-HFs with SV physiology (6.6%; OR 1.6, 95% CI 1.1 to 2.3) or 2V physiology (6.3%; OR 1.4, 95% CI 1.3 to 1.5) versus HF-non-ACHD (5.5%). ACHF-HF hospitalisations increased more (46% vs 6% HF-non-ACHD) over a 10-year period, but the proportion receiving ventricular assist device (VAD) (ACHD-HF -2% vs HF-non-ACHD 294%) or transplant (ACHD-HF -37% vs HF-non-ACHD 73%) decreased. CONCLUSION ACHD-HFs have significant ED and hospital resource use that has increased over the past 10 years. However, advanced HF therapies (VAD and transplantation) are less commonly used compared with those without adult congenital heart disease.
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Affiliation(s)
- Danielle S Burstein
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph W Rossano
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Heather Griffis
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Xuemei Zhang
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rachel Fowler
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benjamin Frischertz
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yuli Y Kim
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - JoAnn Lindenfield
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeremy A Mazurek
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan B Edelson
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jonathan N Menachem
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Garcia-Marcinkiewicz AG, Kovatsis PG, Hunyady AI, Olomu PN, Zhang B, Sathyamoorthy M, Gonzalez A, Kanmanthreddy S, Gálvez JA, Franz AM, Peyton J, Park R, Kiss EE, Sommerfield D, Griffis H, Nishisaki A, von Ungern-Sternberg BS, Nadkarni VM, McGowan FX, Fiadjoe JE. First-attempt success rate of video laryngoscopy in small infants (VISI): a multicentre, randomised controlled trial. Lancet 2020; 396:1905-1913. [PMID: 33308472 DOI: 10.1016/s0140-6736(20)32532-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [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] [Received: 09/15/2020] [Revised: 09/26/2020] [Accepted: 10/08/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Orotracheal intubation of infants using direct laryngoscopy can be challenging. We aimed to investigate whether video laryngoscopy with a standard blade done by anaesthesia clinicians improves the first-attempt success rate of orotracheal intubation and reduces the risk of complications when compared with direct laryngoscopy. We hypothesised that the first-attempt success rate would be higher with video laryngoscopy than with direct laryngoscopy. METHODS In this multicentre, parallel group, randomised controlled trial, we recruited infants without difficult airways abnormalities requiring orotracheal intubation in operating theatres at four quaternary children's hospitals in the USA and one in Australia. We randomly assigned patients (1:1) to video laryngoscopy or direct laryngoscopy using random permuted blocks of size 2, 4, and 6, and stratified by site and clinician role. Guardians were masked to group assignment. The primary outcome was the proportion of infants with a successful first attempt at orotracheal intubation. Analysis (modified intention-to-treat [mITT] and per-protocol) used a generalised estimating equation model to account for clustering of patients treated by the same clinician and institution, and adjusted for gestational age, American Society of Anesthesiologists physical status, weight, clinician role, and institution. The trial is registered at ClinicalTrials.gov, NCT03396432. FINDINGS Between June 4, 2018, and Aug 19, 2019, 564 infants were randomly assigned: 282 (50%) to video laryngoscopy and 282 (50%) to direct laryngoscopy. The mean age of infants was 5·5 months (SD 3·3). 274 infants in the video laryngoscopy group and 278 infants in the direct laryngoscopy group were included in the mITT analysis. In the video laryngoscopy group, 254 (93%) infants were successfully intubated on the first attempt compared with 244 (88%) in the direct laryngoscopy group (adjusted absolute risk difference 5·5% [95% CI 0·7 to 10·3]; p=0·024). Severe complications occurred in four (2%) infants in the video laryngoscopy group compared with 15 (5%) in the direct laryngoscopy group (-3·7% [-6·5 to -0·9]; p=0·0087). Fewer oesophageal intubations occurred in the video laryngoscopy group (n=1 [<1%]) compared with in the direct laryngoscopy group (n=7 [3%]; -2·3 [-4·3 to -0·3]; p=0·028). INTERPRETATION Among anaesthetised infants, using video laryngoscopy with a standard blade improves the first-attempt success rate and reduces complications. FUNDING Anaesthesia Patient Safety Foundation, Society for Airway Management, and Karl Storz Endoscopy.
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Affiliation(s)
- Annery G Garcia-Marcinkiewicz
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Pete G Kovatsis
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital Boston, MA, USA
| | - Agnes I Hunyady
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Patrick N Olomu
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Health System of Texas, Dallas, TX, USA
| | - Bingqing Zhang
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Adolfo Gonzalez
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Health System of Texas, Dallas, TX, USA
| | - Siri Kanmanthreddy
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Jorge A Gálvez
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amber M Franz
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - James Peyton
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital Boston, MA, USA
| | - Raymond Park
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital Boston, MA, USA
| | - Edgar E Kiss
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Health System of Texas, Dallas, TX, USA
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, University of Western Australia, Nedlands, WA, Australia
| | - Heather Griffis
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, University of Western Australia, Nedlands, WA, Australia
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Francis X McGowan
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John E Fiadjoe
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Matesanz S, Edelson J, Iacobellis K, Mejia E, Brandsema J, Wittlieb-Weber C, Griffis H, Okunowo O, Lin K. REGISTRIES, CARE, QUALITY OF LIFE, MANAGEMENT OF NMD. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.345] [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: 10/23/2022]
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Reza N, Edwards JJ, Katcoff H, Mondal A, Griffis H, Rossano JW, Lin KY, Owens AT, Birati EY, Edelson JB. Sex Differences in Left Ventricular Assist Device-related Emergency Department Visits in the United States. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.422] [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: 11/28/2022]
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Nfonoyim B, Griffis H, Guevara J. Disparities in Childhood Attention Deficit Hyperactivity Disorder Symptom Severity by Neighborhood Poverty. Acad Pediatr 2020; 20:917-925. [PMID: 32081765 DOI: 10.1016/j.acap.2020.02.015] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 02/03/2020] [Accepted: 02/13/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the association between neighborhood poverty and Attention Deficit Hyperactivity Disorder (ADHD) severity among children in a large metropolitan area. METHODS This is a secondary analysis of data collected April 2016 to July 2017 at the Children's Hospital of Philadelphia Care Network. We attributed 2015 American Community Survey census tract poverty, defined as percent of individuals with income below poverty level, to each child's residential address. Tracts were grouped from low to high poverty. ADHD severity was determined by Vanderbilt Parent Rating Scale (VPRS) symptom score. We also recorded parent-reported child ADHD medication use. RESULTS A total of 286 children were linked to 203 unique census tracts. The majority of children from high poverty tracts were black and from disadvantaged households. Higher neighborhood poverty was associated with higher VPRS scores and decreased medication use in bivariate analysis. Poverty was no longer associated with VPRS scores in multivariate analysis, but medication use still had a significant negative association with VPRS score. Post hoc stratification by medication use revealed that neighborhood poverty and VPRS score were significantly associated for children on medication, but not for those off medication. CONCLUSIONS Neighborhood poverty was not associated with ADHD severity in multivariate analysis. This suggests other factors, including medication use, confound the relationship between neighborhood poverty and ADHD severity. Lack of medication treatment was significantly associated with higher symptom burdens for children with access to primary care. Decreased medication use in higher poverty communities warrants exploration and public health interventions to ensure adequate ADHD management for all children.
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Affiliation(s)
- Bianca Nfonoyim
- Perelman School of Medicine, University of Pennsylvania (B Nfonoyim and J Guevara), Philadelphia, Pa; PolicyLab, The Children's Hospital of Philadelphia (B Nfonoyim, H Griffis, and J Guevara), Philadelphia, Pa.
| | - Heather Griffis
- PolicyLab, The Children's Hospital of Philadelphia (B Nfonoyim, H Griffis, and J Guevara), Philadelphia, Pa
| | - James Guevara
- Perelman School of Medicine, University of Pennsylvania (B Nfonoyim and J Guevara), Philadelphia, Pa; PolicyLab, The Children's Hospital of Philadelphia (B Nfonoyim, H Griffis, and J Guevara), Philadelphia, Pa; Department of Pediatrics, The Children's Hospital of Philadelphia (J Guevara), Philadelphia, Pa
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Lang SS, Valeri A, Zhang B, Storm PB, Heuer GG, Leavesley L, Bellah R, Kim CT, Griffis H, Kilbaugh TJ, Huh JW. Head of bed elevation in pediatric patients with severe traumatic brain injury. J Neurosurg Pediatr 2020; 26:465-475. [PMID: 32679558 DOI: 10.3171/2020.4.peds20102] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Head of bed (HOB) elevation to 30° after severe traumatic brain injury (TBI) has become standard positioning across all age groups. This maneuver is thought to minimize the risk of elevated ICP in the hopes of decreasing cerebral blood and fluid volume and increasing cerebral venous outflow with improvement in jugular venous drainage. However, HOB elevation is based on adult population data due to a current paucity of pediatric TBI studies regarding HOB management. In this prospective study of pediatric patients with severe TBI, the authors investigated the role of different head positions on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and cerebral venous outflow through the internal jugular veins (IJVs) on postinjury days 2 and 3 because these time periods are considered the peak risk for intracranial hypertension. METHODS Patients younger than 18 years with a Glasgow Coma Scale score ≤ 8 after severe TBI were prospectively recruited at a single quaternary pediatric intensive care unit. All patients had an ICP monitor placed, and no other neurosurgical procedure was performed. On the 2nd and 3rd days postinjury, the degree of HOB elevation was varied between 0° (head-flat or horizontal), 10°, 20°, 30°, 40°, and 50° while ICP, CPP, and bilateral IJV blood flows were recorded. RESULTS Eighteen pediatric patients with severe TBI were analyzed. On each postinjury day, 13 of the 18 patients had at least 1 optimal HOB position (the position that simultaneously demonstrated the lowest ICP and the highest CPP). Six patients on each postinjury day had 30° as the optimal HOB position, with only 2 being the same patient on both postinjury days. On postinjury day 2, 3 patients had more than 1 optimal HOB position, while 5 patients did not have an optimal position. On postinjury day 3, 2 patients had more than 1 optimal HOB position while 5 patients did not have an optimal position. Interestingly, 0° (head-flat or horizontal) was the optimal HOB position in 2 patients on postinjury day 2 and 3 patients on postinjury day 3. The optimal HOB position demonstrated lower right IJV blood flow than a nonoptimal position on both postinjury days 2 (p = 0.0023) and 3 (p = 0.0033). There was no significant difference between optimal and nonoptimal HOB positions in the left IJV blood flow. CONCLUSIONS In pediatric patients with severe TBI, the authors demonstrated that the optimal HOB position (which decreases ICP and improves CPP) is not always at 30°. Instead, the optimal HOB should be individualized for each pediatric TBI patient on a daily basis.
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Affiliation(s)
- Shih-Shan Lang
- 1Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine.,2Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia
| | - Amber Valeri
- 3Department of Neurosurgery, Philadelphia College of Osteopathic Medicine
| | - Bingqing Zhang
- 4Healthcare Analytics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
| | - Phillip B Storm
- 1Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine.,2Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia
| | - Gregory G Heuer
- 1Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine.,2Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia
| | - Lauren Leavesley
- 5Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine
| | - Richard Bellah
- 6Department of Radiology and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine; and
| | - Chong Tae Kim
- 7Department of Physical Medicine and Rehabilitation and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Heather Griffis
- 4Healthcare Analytics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
| | - Todd J Kilbaugh
- 5Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine
| | - Jimmy W Huh
- 5Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine
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Rubin D, Huang J, Fisher BT, Gasparrini A, Tam V, Song L, Wang X, Kaufman J, Fitzpatrick K, Jain A, Griffis H, Crammer K, Morris J, Tasian G. Association of Social Distancing, Population Density, and Temperature With the Instantaneous Reproduction Number of SARS-CoV-2 in Counties Across the United States. JAMA Netw Open 2020; 3:e2016099. [PMID: 32701162 PMCID: PMC7378754 DOI: 10.1001/jamanetworkopen.2020.16099] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Local variation in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) across the United States has not been well studied. OBJECTIVE To examine the association of county-level factors with variation in the SARS-CoV-2 reproduction number over time. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 211 counties, representing state capitals and cities with at least 100 000 residents and including 178 892 208 US residents, in 46 states and the District of Columbia between February 25, 2020, and April 23, 2020. EXPOSURES Social distancing, measured by percentage change in visits to nonessential businesses; population density; and daily wet-bulb temperatures. MAIN OUTCOMES AND MEASURES Instantaneous reproduction number (Rt), or cases generated by each incident case at a given time, estimated from daily case incidence data. RESULTS The 211 counties contained 178 892 208 of 326 289 971 US residents (54.8%). Median (interquartile range) population density was 1022.7 (471.2-1846.0) people per square mile. The mean (SD) peak reduction in visits to nonessential business between April 6 and April 19, as the country was sheltering in place, was 68.7% (7.9%). Median (interquartile range) daily wet-bulb temperatures were 7.5 (3.8-12.8) °C. Median (interquartile range) case incidence and fatality rates per 100 000 people were approximately 10 times higher for the top decile of densely populated counties (1185.2 [313.2-1891.2] cases; 43.7 [10.4-106.7] deaths) than for counties in the lowest density quartile (121.4 [87.8-175.4] cases; 4.2 [1.9-8.0] deaths). Mean (SD) Rt in the first 2 weeks was 5.7 (2.5) in the top decile compared with 3.1 (1.2) in the lowest quartile. In multivariable analysis, a 50% decrease in visits to nonessential businesses was associated with a 45% decrease in Rt (95% CI, 43%-49%). From a relative Rt at 0 °C of 2.13 (95% CI, 1.89-2.40), relative Rt decreased to a minimum as temperatures warmed to 11 °C, increased between 11 and 20 °C (1.61; 95% CI, 1.42-1.84) and then declined again at temperatures greater than 20 °C. With a 70% reduction in visits to nonessential business, 202 counties (95.7%) were estimated to fall below a threshold Rt of 1.0, including 17 of 21 counties (81.0%) in the top density decile and 52 of 53 counties (98.1%) in the lowest density quartile.2. CONCLUSIONS AND RELEVANCE In this cohort study, social distancing, lower population density, and temperate weather were associated with a decreased Rt for SARS-CoV-2 in counties across the United States. These associations could inform selective public policy planning in communities during the coronavirus disease 2019 pandemic.
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Affiliation(s)
- David Rubin
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jing Huang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Brian T. Fisher
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Division of Infectious Disease, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Antonio Gasparrini
- Department of Public Health Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vicky Tam
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lihai Song
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Xi Wang
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jason Kaufman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Kate Fitzpatrick
- Division of Urology, Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Arushi Jain
- Division of Urology, Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heather Griffis
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Koby Crammer
- Department of Electrical Engineering, The Technion, Haifa, Israel
| | - Jeffrey Morris
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Gregory Tasian
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Division of Urology, Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Edwards J, Edelson J, Katcoff H, Mondal A, Reza N, Griffis H, Ravishankar C, Rossano J, Lin K, Birati E. Age-Dependent Emergency Department Resource Utilization in Patients with a Ventricular Assist Device. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.318] [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: 10/24/2022] Open
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Edelson J, Edwards J, Katcoff H, Mondal A, Reza N, Mazurek J, Wald J, Griffis H, Burstein D, Rossano J, Lin K, Birati E. Epidemiology of Patients with Ventricular Assist Devices Presenting to the Emergency Room from 2006-2014. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.362] [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: 11/30/2022] Open
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Kaplinski M, Griffis H, Liu F, Tinker C, Laney NC, Mendoza M, Cohen MS, Meyers K, Natarajan SS. Clinical Innovation: A Multidisciplinary Program for the Diagnosis and Treatment of Systemic Hypertension in Children and Adolescents. Clin Pediatr (Phila) 2020; 59:228-235. [PMID: 31893928 DOI: 10.1177/0009922819898180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 11/17/2022]
Abstract
Pediatric systemic hypertension (HTN) is underdiagnosed and undertreated. The Divisions of Cardiology and Nephrology at our institution developed a comprehensive outpatient HTN program to (1) screen children at risk for HTN, (2) assess cardiovascular health, and (3) optimize medical management. We report our findings during all initial visits (n = 304) from December 2011 to September 2018. Of the cohort, 38% were obese and 36% reported little to no exercise. More than half of patients ≥11 years old did not have recommended lipid screening. When evaluating ambulatory blood pressure monitoring results, clinic blood pressure did not accurately diagnose patients with or without HTN and many patients on antihypertensive medications were inadequately treated. Visit recommendations included addition of or changes to antihypertensive medication in 35% of patients. A multidisciplinary program dedicated to pediatric HTN helps screen patients who are at risk. Ambulatory blood pressure monitoring identifies HTN in patients with normal clinic blood pressure and those on antihypertensive medication.
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Affiliation(s)
- Michelle Kaplinski
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Heather Griffis
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Fang Liu
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Craig Tinker
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Nina C Laney
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Melodee Mendoza
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Meryl S Cohen
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Meyers
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Shobha S Natarajan
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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Edelson J, Matesanz S, Iacobellis K, Mejia E, Rossano J, O'Connor MJ, Burstein D, Brandsema J, Griffis H, Okunowo O, Lin K. HEALTHCARE UTILIZATION IN PEDIATRIC PATIENTS WITH MUSCULAR DYSTROPHY IN THE UNITED STATES. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31723-x] [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: 11/25/2022]
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Griffis H, Asch DA, Schwartz HA, Ungar L, Buttenheim AM, Barg FK, Mitra N, Merchant RM. Using Social Media to Track Geographic Variability in Language About Diabetes: Analysis of Diabetes-Related Tweets Across the United States. JMIR Diabetes 2020; 5:e14431. [PMID: 32044757 PMCID: PMC7055793 DOI: 10.2196/14431] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/23/2019] [Accepted: 11/11/2019] [Indexed: 11/28/2022] Open
Abstract
Background Social media posts about diabetes could reveal patients’ knowledge, attitudes, and beliefs as well as approaches for better targeting of public health messages and care management. Objective This study aimed to characterize the language of Twitter users’ posts regarding diabetes and describe the correlation of themes with the county-level prevalence of diabetes. Methods A retrospective study of diabetes-related tweets identified from a random sample of approximately 37 billion tweets from the United States from 2009 to 2015 was conducted. We extracted diabetes-specific tweets and used machine learning to identify statistically significant topics of related terms. Topics were combined into themes and compared with the prevalence of diabetes by US counties and further compared with geography (US Census Divisions). Pearson correlation coefficients are reported for each topic and relationship with prevalence. Results A total of 239,989 tweets from 121,494 unique users included the term diabetes. The themes emerging from the topics included unhealthy food and drink, treatment, symptoms/diagnoses, risk factors, research, recipes, news, health care, management, fundraising, diet, communication, and supplements/remedies. The theme of unhealthy foods most positively correlated with geographic areas with high prevalence of diabetes (r=0.088), whereas tweets related to research most negatively correlated (r=−0.162) with disease prevalence. Themes and topics about diabetes differed in overall frequency across the US geographical divisions, with the East South Central and South Atlantic states having a higher frequency of topics referencing unhealthy food (r range=0.073-0.146; P<.001). Conclusions Diabetes-related tweets originating from counties with high prevalence of diabetes have different themes than tweets originating from counties with low prevalence of diabetes. Interventions could be informed from this variation to promote healthy behaviors.
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Affiliation(s)
- Heather Griffis
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - David A Asch
- University of Pennsylvania, Philadelphia, PA, United States
| | | | - Lyle Ungar
- University of Pennsylvania, Philadelphia, PA, United States
| | | | - Frances K Barg
- University of Pennsylvania, Philadelphia, PA, United States
| | - Nandita Mitra
- University of Pennsylvania, Philadelphia, PA, United States
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Esangbedo I, Yu P, Raymond T, Niles DE, Hanna R, Zhang X, Wolfe H, Griffis H, Nadkarni V. Pediatric in-hospital CPR quality at night and on weekends. Resuscitation 2020; 146:56-63. [DOI: 10.1016/j.resuscitation.2019.10.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
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Trowbridge A, Bamat T, Griffis H, McConathey E, Feudtner C, Walter JK. Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital. Acad Pediatr 2020; 20:81-88. [PMID: 31376579 PMCID: PMC6944767 DOI: 10.1016/j.acap.2019.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/29/2018] [Revised: 06/11/2019] [Accepted: 07/16/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Pediatric residents are expected to be competent in end-of-life (EOL) care. We aimed to quantify pediatric resident exposure to patient deaths, and the context of these exposures. METHODS Retrospective chart review of all deceased patients at one children's hospital over 3 years collected patient demographics, time, and location of death. Mode of death was determined after chart review. Each death was cross-referenced with pediatric resident call schedules to determine residents involved within 48 hours of death. Descriptive statistics are presented. RESULTS Of 579 patients who died during the study period, 46% had resident involvement. Most deaths occurred in the NICU (30% of all deaths); however, resident exposure to EOL care most commonly occurred in the PICU (52% of resident exposures) and were after withdrawals of life-sustaining therapy (41%), followed by nonescalation (31%) and failed resuscitation (15%). During their postgraduate year (PGY)-1, <1% of residents encountered a patient death. During PGY-2 and PGY-3, 96% and 78%, respectively, of residents encountered at least 1 death. During PGY-2, residents encountered a mean of 3.5 patient deaths (range 0-12); during PGY-3, residents encountered a mean of 1.4 deaths (range 0-5). Residents observed for their full 3-year residency encountered a mean of 5.6 deaths (range 2-10). CONCLUSIONS Pediatric residents have limited but variable exposure to EOL care, with most exposures in the ICU after withdrawal of life-sustaining technology. Educators should consider how to optimize EOL education with limited clinical exposure, and design resident support and education with these variable exposures in mind.
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Affiliation(s)
- Amy Trowbridge
- Division of Bioethics and Palliative Care, Seattle Children's Hospital and University of Washington (A Trowbridge), Seattle, Wash.
| | - Tara Bamat
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia (T Bamat, E McConathey, C Feudtner, and JK Walter), Philadelphia, Pa
| | - Heather Griffis
- PolicyLab, The Children's Hospital of Philadelphia (H Griffis), Philadelphia, Pa
| | - Eric McConathey
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia (T Bamat, E McConathey, C Feudtner, and JK Walter), Philadelphia, Pa
| | - Chris Feudtner
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia (T Bamat, E McConathey, C Feudtner, and JK Walter), Philadelphia, Pa; Department of Medical Ethics, The Children's Hospital of Philadelphia (C Feudtner and JK Walter), Philadelphia, Pa
| | - Jennifer K Walter
- Pediatric Advanced Care Team, The Children's Hospital of Philadelphia (T Bamat, E McConathey, C Feudtner, and JK Walter), Philadelphia, Pa; Department of Medical Ethics, The Children's Hospital of Philadelphia (C Feudtner and JK Walter), Philadelphia, Pa
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Otero HJ, White AM, Khwaja AB, Griffis H, Katcoff H, Bresnahan BW. Imaging Intussusception in Children’s Hospitals in the United States: Trends, Outcomes, and Costs. J Am Coll Radiol 2019; 16:1636-1644. [DOI: 10.1016/j.jacr.2019.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 11/26/2022]
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Griffis H, Wu L, Naim MY, Bradley R, Tobin J, McNally B, Vellano K, Quan L, Markenson D, Rossano JW. Characteristics and outcomes of AED use in pediatric cardiac arrest in public settings: The influence of neighborhood characteristics. Resuscitation 2019; 146:126-131. [PMID: 31785372 DOI: 10.1016/j.resuscitation.2019.09.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Automated external defibrillators (AEDs) are critical in the chain of survival following out-of-hospital cardiac arrest (OHCA), yet few studies have reported on AED use and outcomes among pediatric OHCA. This study describes the association between bystander AED use, neighborhood characteristics and survival outcomes following public pediatric OHCA. METHODS Non-traumatic OHCAs among children less than18 years of age in a public setting between from January 1, 2013 through December 31, 2017 were identified in the CARES database. A neighborhood characteristic index was created from the addition of dichotomous values of 4 American Community Survey neighborhood characteristics at the Census tract level: median household income, percent high school graduates, percent unemployment, and percent African American. Multivariable logistic regression models assessed the association of OHCA characteristics, the neighborhood characteristic index and outcomes. RESULTS Of 971 pediatric OHCA, AEDs were used by bystanders in 10.3% of OHCAs. AEDs were used on 2.3% of children ≤1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p < 0.001). AED use was more common in neighborhoods with a median household income of >$50,000 per year (12.3%; p = 0.016), <10% unemployment (12.1%; p = 0.002), and >80% high school education (11.8%; p = 0.002). Greater survival to hospital discharge and neurologically favorable survival were among arrests with bystander AED use, varying by neighborhood characteristics. CONCLUSIONS Bystander AED use is uncommon in pediatric OHCA, particularly in high-risk neighborhoods, but improves survival. Further study is needed to understand disparities in AED use and outcomes.
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Affiliation(s)
- H Griffis
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, United States; Department of Biomedical Health Informatics, The Children's Hospital of Philadelphia, United States; Cardiac Center Research Core, The Children's Hospital of Philadelphia, United States.
| | - L Wu
- The Children's Hospital of Philadelphia, United States
| | - M Y Naim
- Cardiac Center Research Core, The Children's Hospital of Philadelphia, United States; The Children's Hospital of Philadelphia, United States; Division of Critical Care, The Children's Hospital of Philadelphia, United States
| | - R Bradley
- Division of Emergency Medical Services and Disaster Medicine, University of Texas Health Science Center, United States
| | - J Tobin
- Division of Trauma Anesthesiology, University of Southern California, United States
| | - B McNally
- Department of Emergency Medicine, Emory University, United States
| | - K Vellano
- Department of Emergency Medicine, Emory University, United States
| | - L Quan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, United States
| | | | - J W Rossano
- Cardiac Center Research Core, The Children's Hospital of Philadelphia, United States; The Children's Hospital of Philadelphia, United States; Division of Critical Care, The Children's Hospital of Philadelphia, United States
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Edelson JB, Rossano JW, Griffis H, Dai D, Faerber J, Ravishankar C, Mascio CE, Mercer-Rosa LM, Glatz AC, Lin KY. Emergency Department Visits by Children With Congenital Heart Disease. J Am Coll Cardiol 2019; 72:1817-1825. [PMID: 30286926 DOI: 10.1016/j.jacc.2018.07.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 04/13/2018] [Revised: 06/15/2018] [Accepted: 07/12/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data related to the epidemiology and resource utilization of congenital heart disease (CHD)-related emergency department (ED) visits in the pediatric population is limited. OBJECTIVES The purpose of this analysis was to describe national estimates of pediatric CHD-related ED visits and evaluate medical complexity, admissions, resource utilization, and mortality. METHODS This was an epidemiological analysis of ED visit-level data from the 2006 to 2014 Nationwide Emergency Department Sample. Patients age <18 years with CHD were identified using International Classification of Diseases-9th Revision-Clinical Modification codes. We evaluated time trends using weighted regression and tested the hypothesis that medical complexity, resource utilization, and mortality are higher in CHD patients. RESULTS A total of 420,452 CHD-related ED visits (95% confidence interval [CI]: 416,897 to 422,443 visits) were identified, accounting for 0.17% of all pediatric ED visits. Those with CHD were more likely to be <1 year of age (43% vs. 13%), and to have ≥1 complex chronic condition (35% vs. 2%). CHD-related ED visits had higher rates of inpatient admission (46% vs. 4%; adjusted odds ratio: 1.89; 95% CI: 1.85 to 1.93), higher median ED charges ($1,266 [interquartile range (IQR): $701 to $2,093] vs. $741 [IQR: $401 to $1,332]), and a higher mortality rate (1% vs. 0.04%; adjusted odds ratio: 1.25; 95% CI: 1.07 to 1.45). Adjusted median charges for CHD-related ED visits increased from $1,219 (IQR: $673 to $2,138) to $1,630 (IQR: $901 to $2,799), while the mortality rate decreased from 1.13% (95% CI: 0.71% to 1.52%) to 0.75% (95% CI: 0.41% to 1.09%) over the 9 years studied. CONCLUSIONS Children with CHD presenting to the ED represent a medically complex population at increased risk for morbidity, mortality, and resource utilization compared with those without CHD. Over 9 years, charges increased, but the mortality rate improved.
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Affiliation(s)
- Jonathan B Edelson
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Joseph W Rossano
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heather Griffis
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dingwei Dai
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer Faerber
- Healthcare Analytics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chitra Ravishankar
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher E Mascio
- Department of Pediatrics, Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Laura M Mercer-Rosa
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrew C Glatz
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kimberly Y Lin
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Walter JK, Schall TE, DeWitt AG, Faerber J, Griffis H, Galligan M, Miller V, Arnold RM, Feudtner C. Interprofessional Team Member Communication Patterns, Teamwork, and Collaboration in Pre-family Meeting Huddles in a Pediatric Cardiac Intensive Care Unit. J Pain Symptom Manage 2019; 58:11-18. [PMID: 31004773 PMCID: PMC6800217 DOI: 10.1016/j.jpainsymman.2019.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 02/15/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 11/28/2022]
Abstract
CONTEXT Interprofessional teams often develop a care plan before engaging in a family meeting in the pediatric cardiac intensive care unit (CICU)-a process that can affect the course of the family meeting and alter team dynamics but that has not been studied. OBJECTIVES To characterize the types of interactions that interprofessional team members have in pre-family meeting huddles in the pediatric CICU by 1) evaluating the amount of time each team member speaks; 2) assessing team communication and teamwork using standardized instruments; and 3) measuring team members' perceptions of collaboration and satisfaction with decision making. METHODS We conducted a prospective observational study in a pediatric CICU. Subjects were members of the interprofessional team attending preparation meetings before care meetings with families of patients admitted to the CICU for longer than two weeks. We quantitatively coded the amount each team member spoke. We assessed team performance of communication and teamwork using the PACT-Novice tool, and we measured perception of collaboration and satisfaction with decision making using the Collaboration and Satisfaction About Care Decisions questionnaire. RESULTS Physicians spoke for an average of 83.9% of each meeting's duration (SD 7.5%); nonphysicians averaged 9.9% (SD 5.2%). Teamwork behaviors were present and adequately performed as judged by trained observers. Significant differences in physician and nonphysician perceptions of collaboration were found in three of 10 observed meetings. CONCLUSION Interprofessional team members' interactions in team meetings provide important information about team dynamics, revealing potential opportunities for improved collaboration and communication in team meetings and subsequent family meetings.
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Affiliation(s)
- Jennifer K Walter
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
| | - Theodore E Schall
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Aaron G DeWitt
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer Faerber
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Heather Griffis
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Meghan Galligan
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Victoria Miller
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert M Arnold
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Chris Feudtner
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Lisanti AJ, Fitzgerald J, Helman S, Dean S, Sorbello A, Griffis H. Nursing Practice With Transthoracic Intracardiac Catheters in Children: International Benchmarking Study. Am J Crit Care 2019; 28:174-181. [PMID: 31043397 DOI: 10.4037/ajcc2019350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/01/2022]
Abstract
BACKGROUND Transthoracic intracardiac catheters are central catheters placed in the operating room at the conclusion of cardiac surgery for infants and children. Complications associated with these catheters (eg, bleeding, migration, premature removal, infection, leakage, and lack of function) have been described. However, no researchers have addressed the nursing management of these catheters in the intensive care unit, including catheter dressing and securement, mobilization of patients, and flushing the catheters, or the impact of these interventions on patients' outcomes. OBJECTIVES To internationally benchmark current nursing practice associated with care of infants and children with transthoracic intracardiac catheters. METHODS In a cross-sectional, descriptive study of nursing practice in infants and children with transthoracic intracardiac catheters, a convenience sample of bedside and advanced practice nurses was recruited to complete an online survey to benchmark current practice. The survey included questions on criteria for catheter insertion and removal, dressing care, flushing practice, securement, and mobilization of patients. RESULTS Transthoracic intracardiac catheters are used by most centers that provide care for infants and children after open heart surgery. A wide range of practices was reported. CONCLUSIONS Standardizing the use and care of transthoracic intracardiac catheters can improve the safety and efficacy of their use in infants and children and promote safe and early postoperative mobilization of patients.
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Affiliation(s)
- Amy Jo Lisanti
- Amy Jo Lisanti is a Ruth L. Kirschstein NRSA Postdoctoral Fellow at the University of Pennsylvania School of Nursing in Philadelphia and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Jamie Fitzgerald is a safety and quality specialist at Children's Hospital of Philadelphia. Stephanie Helman was a clinical nurse specialist at Children's Hospital of Philadelphia when the study was done. She is now a doctoral student at the University of Pittsburgh, Pittsburgh, Pennsylvania. Spencer Dean is a staff nurse in the cardiac intensive care unit at Children's Hospital of Philadelphia. Andrea Sorbello is a nurse practitioner and advanced practice provider team lead at Children's Hospital of Philadelphia. Heather Griffis is director of the Health Care Analytics Unit at Children's Hospital of Philadelphia.
| | - Jamie Fitzgerald
- Amy Jo Lisanti is a Ruth L. Kirschstein NRSA Postdoctoral Fellow at the University of Pennsylvania School of Nursing in Philadelphia and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Jamie Fitzgerald is a safety and quality specialist at Children's Hospital of Philadelphia. Stephanie Helman was a clinical nurse specialist at Children's Hospital of Philadelphia when the study was done. She is now a doctoral student at the University of Pittsburgh, Pittsburgh, Pennsylvania. Spencer Dean is a staff nurse in the cardiac intensive care unit at Children's Hospital of Philadelphia. Andrea Sorbello is a nurse practitioner and advanced practice provider team lead at Children's Hospital of Philadelphia. Heather Griffis is director of the Health Care Analytics Unit at Children's Hospital of Philadelphia
| | - Stephanie Helman
- Amy Jo Lisanti is a Ruth L. Kirschstein NRSA Postdoctoral Fellow at the University of Pennsylvania School of Nursing in Philadelphia and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Jamie Fitzgerald is a safety and quality specialist at Children's Hospital of Philadelphia. Stephanie Helman was a clinical nurse specialist at Children's Hospital of Philadelphia when the study was done. She is now a doctoral student at the University of Pittsburgh, Pittsburgh, Pennsylvania. Spencer Dean is a staff nurse in the cardiac intensive care unit at Children's Hospital of Philadelphia. Andrea Sorbello is a nurse practitioner and advanced practice provider team lead at Children's Hospital of Philadelphia. Heather Griffis is director of the Health Care Analytics Unit at Children's Hospital of Philadelphia
| | - Spencer Dean
- Amy Jo Lisanti is a Ruth L. Kirschstein NRSA Postdoctoral Fellow at the University of Pennsylvania School of Nursing in Philadelphia and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Jamie Fitzgerald is a safety and quality specialist at Children's Hospital of Philadelphia. Stephanie Helman was a clinical nurse specialist at Children's Hospital of Philadelphia when the study was done. She is now a doctoral student at the University of Pittsburgh, Pittsburgh, Pennsylvania. Spencer Dean is a staff nurse in the cardiac intensive care unit at Children's Hospital of Philadelphia. Andrea Sorbello is a nurse practitioner and advanced practice provider team lead at Children's Hospital of Philadelphia. Heather Griffis is director of the Health Care Analytics Unit at Children's Hospital of Philadelphia
| | - Andrea Sorbello
- Amy Jo Lisanti is a Ruth L. Kirschstein NRSA Postdoctoral Fellow at the University of Pennsylvania School of Nursing in Philadelphia and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Jamie Fitzgerald is a safety and quality specialist at Children's Hospital of Philadelphia. Stephanie Helman was a clinical nurse specialist at Children's Hospital of Philadelphia when the study was done. She is now a doctoral student at the University of Pittsburgh, Pittsburgh, Pennsylvania. Spencer Dean is a staff nurse in the cardiac intensive care unit at Children's Hospital of Philadelphia. Andrea Sorbello is a nurse practitioner and advanced practice provider team lead at Children's Hospital of Philadelphia. Heather Griffis is director of the Health Care Analytics Unit at Children's Hospital of Philadelphia
| | - Heather Griffis
- Amy Jo Lisanti is a Ruth L. Kirschstein NRSA Postdoctoral Fellow at the University of Pennsylvania School of Nursing in Philadelphia and a clinical nurse specialist/nurse researcher at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Jamie Fitzgerald is a safety and quality specialist at Children's Hospital of Philadelphia. Stephanie Helman was a clinical nurse specialist at Children's Hospital of Philadelphia when the study was done. She is now a doctoral student at the University of Pittsburgh, Pittsburgh, Pennsylvania. Spencer Dean is a staff nurse in the cardiac intensive care unit at Children's Hospital of Philadelphia. Andrea Sorbello is a nurse practitioner and advanced practice provider team lead at Children's Hospital of Philadelphia. Heather Griffis is director of the Health Care Analytics Unit at Children's Hospital of Philadelphia
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Biko DM, DeWitt AG, Pinto EM, Morrison RE, Johnstone JA, Griffis H, O'Byrne ML, Fogel MA, Harris MA, Partington SL, Whitehead KK, Saul D, Goldberg DJ, Rychik J, Glatz AC, Gillespie MJ, Rome JJ, Dori Y. MRI Evaluation of Lymphatic Abnormalities in the Neck and Thorax after Fontan Surgery: Relationship with Outcome. Radiology 2019; 291:774-780. [PMID: 30938628 DOI: 10.1148/radiol.2019180877] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The Fontan operation is performed for surgical palliation of single ventricle physiology. This operation is usually preceded by a superior cavopulmonary connection (SCPC); lymphatic abnormalities after SCPC may be demonstrated at MRI and prior to the Fontan operation. Purpose To determine if the degree of neck and thoracic lymphatic abnormalities at T2-weighted MRI in patients after superior cavopulmonary connection (SCPC) correlated with surgical outcomes from the Fontan procedure. Materials and Methods Patients for whom SCPC was performed for palliation of single ventricle disease who underwent chest MRI between July 2012 and May 2015 at a single institution were retrospectively reviewed. T2-weighted images were scored as lymphatic type 1 (little or no T2 mediastinal and supraclavicular signal) to type 4 (T2 signal into both the mediastinum and the lung parenchyma). Fontan takedown, duration of post-Fontan hospitalization and pleural effusion, postoperative plastic bronchitis, need for transplant, and mortality were tabulated. The relationship between lymphatic type and clinical outcomes was evaluated by using analysis of variance (ANOVA), the Kruskal-Wallis H test, and the Fisher exact test. Results A total of 83 patients (mean age, 7.9 years ± 2.6) were evaluated. Among these 83 patients, 53 (64%) were classified with type 1 or 2 lymphatic abnormalities, 17 (20%) with type 3, and 12 (16%) with type 4. The rate of failure of Fontan completion was higher in patients with type 4 than in type 1 or 2 (54% vs 2%, respectively; P = .004). Need for cardiac transplant (one of 13 [8%]) and death (three of 13 [23%]) occurred only in type 4. Median postoperative length of stay was longer for patients with type 4 than for those with types 1 or 2 (29 days vs 9 days, respectively; P < .01). Conclusion Greater MRI-based severity of lymphatic abnormalities in patients prior to planned Fontan procedure was associated with failure of Fontan completion and longer postoperative stay. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- David M Biko
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Aaron G DeWitt
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Erin M Pinto
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Rodney E Morrison
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Jordan A Johnstone
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Heather Griffis
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Michael L O'Byrne
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Mark A Fogel
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Matthew A Harris
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Sara L Partington
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Kevin K Whitehead
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - David Saul
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - David J Goldberg
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Jack Rychik
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Andrew C Glatz
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Matthew J Gillespie
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Jonathan J Rome
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
| | - Yoav Dori
- From the Department of Radiology (D.M.B., D.S.) and Division of Cardiology (A.G.D., E.M.P., R.E.M., J.A.J., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.), Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and University of Pennsylvania School of Medicine, Philadelphia, PA (D.M.B., A.G.D., H.G., M.L.O., M.A.F., M.A.H., S.L.P., K.K.W., D.S., D.J.G., J.R., A.C.G., M.J.G., J.J.R., Y.D.)
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