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Heyming T, Knudsen-Robbins C, Schomberg J, Hayakawa J, Lara B, Bacon K, Valdez B, Wickens M, Shelton SK, Romain J, Wallace E, Taraman S, Loudon W, Pearson R. Evaluation of Quantitative Pupillometry in Acute Postinjury Pediatric Concussion. Pediatr Neurol 2024; 153:103-112. [PMID: 38367484 DOI: 10.1016/j.pediatrneurol.2024.01.016] [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: 06/21/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Although millions of children sustain concussions each year, a rapid and objective test for concussion has remained elusive. The aim of this study was to investigate quantitative pupillometry in pediatric patients in the acute, postinjury setting. METHODS This was a prospective case-control study of concussed patients presenting to the emergency department within 72 hours of injury. Pupillary measurements were gathered using NeurOptics' PLR 3000; evaluation included a symptom checklist and neurocognitive assessment. Data were analyzed using descriptive statistics and regression models. RESULTS A total of 126 participants were enrolled. One significant difference in pupillometry between concussed and control participants was found: left minimum pupil diameter in 12- to 18 year-olds (P = 0.02). Models demonstrating odds of a concussion revealed significant associations for time to 75% recovery (T75) of the left pupil in five- to 11-year-olds and average dilation velocity of the left pupil in 12- to 18-year-olds (P = 0.03 and 0.02 respectively). Models predicting symptom improvement showed one significant association: percent change of the right pupil in five-to-11-year-olds (P = 0.02). Models predicting neurocognitive improvement in 12- to 18-year-olds demonstrated significant association in T75 in the left pupil for visual memory, visual motor processing speed, and reaction time (P = 0.002, P = 0.04, P = 0.04). CONCLUSIONS The limited statistically significant associations found in this study suggest that pupillometry may not be useful in pediatrics in the acute postinjury setting for either the diagnosis of concussion or to stratify risk for prolonged recovery.
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Affiliation(s)
- Theodore Heyming
- CHOC Children's Hospital, Orange, California; Department of Emergency Medicine, University of California, Irvine, California.
| | - Chloe Knudsen-Robbins
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
| | | | | | - Bryan Lara
- CHOC Children's Hospital, Orange, California
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2
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Lim PS, Fortier MA, Bender M, Campos B, Heyming T, Kain ZN. Language barriers and pain disparities in pediatric emergency settings: A call for action. Acad Emerg Med 2024. [PMID: 38497351 DOI: 10.1111/acem.14894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Paulina S Lim
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, California, USA
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, USA
| | - Michelle A Fortier
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, USA
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Children's Hospital of Orange County, Irvine, California, USA
| | - Miriam Bender
- Sue and Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
| | - Belinda Campos
- Chicano/Latino Studies, University of California, Irvine, California, USA
| | - Theodore Heyming
- Emergency Medicine, Children's Hospital of Orange County, Orange, California, USA
| | - Zeev N Kain
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, California, USA
- UCI Center on Stress and Health, University of California Irvine, Irvine, California, USA
- Children's Hospital of Orange County, Irvine, California, USA
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Martin SR, Heyming T, Morphew T, Sayrs L, Fortier MA, Sanger T, Kain ZN. Impact of COVID-19 pandemic on pediatric healthcare burnout in acute care: a longitudinal study. Pediatr Res 2023; 94:1771-1778. [PMID: 37301924 PMCID: PMC10257162 DOI: 10.1038/s41390-023-02674-3] [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] [Received: 10/07/2022] [Revised: 04/12/2023] [Accepted: 05/08/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND COVID-19 pandemic introduced significant challenges that may have exacerbated healthcare worker (HCW) burnout. To date, assessments of burnout during COVID-19 pandemic have been cross-sectional, limiting our understanding of changes in burnout. This longitudinal study assessed change across time in pediatric HCW burnout during the COVID-19 pandemic and whether demographic and psychological factors were associated with changes in burnout. METHODS This longitudinal study included 162 physicians, physician assistants, nurses, and medical technicians within the emergency department (ED), intensive care, perioperative, and inter-hospital transport services in a children's hospital. HCW demographics, anxiety and personality traits were reported via validated measures. HCWs completed the Maslach Burnout Inventory in April 2020 and March 2021. Data were analyzed using generalized estimating equations. RESULTS The percentage of HCWs reporting high emotional exhaustion and/or depersonalization burnout increased significantly across time (18.5% to 28.4%, P = 0.010). Factors associated with increased emotional exhaustion included working in the ED (P = 0.011) or perioperative department (P < 0.001), being a nurse or medical technician (P's < 0.001), not having children (P < 0.001), and low conscientiousness (P < 0.001). CONCLUSIONS Pediatric HCW burnout significantly increased over 11-months of the COVID-19 pandemic. Results suggest that certain demographic and psychological factors may represent potential area to target for intervention for future pandemics. IMPACT This longitudinal study revealed that the COVID-19 pandemic has had a significant impact on pediatric healthcare worker burnout. The percentage of healthcare workers reporting high levels of emotional exhaustion and depersonalization burnout increased significantly over 11-months of the COVID-19 pandemic. Results suggest that certain demographic and psychological factors may represent potential targets for future interventions.
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Affiliation(s)
- Sarah R Martin
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, CA, USA
- Center on Stress & Health, University of California, Irvine, Irvine, CA, USA
- Children's Hospital of Orange County, Orange, CA, USA
| | - Theodore Heyming
- Children's Hospital of Orange County, Orange, CA, USA
- Emergency Medicine, University of California, Irvine, Irvine, CA, USA
| | - Tricia Morphew
- Morphew Consulting, LLC, Bothell, WA, USA
- Research Institute, Children's Hospital of Orange County, Orange, CA, USA
| | - Lois Sayrs
- Children's Hospital of Orange County, Orange, CA, USA
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Michelle A Fortier
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, CA, USA
- Center on Stress & Health, University of California, Irvine, Irvine, CA, USA
- Children's Hospital of Orange County, Orange, CA, USA
- Sue & Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, USA
| | | | - Zeev N Kain
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, CA, USA.
- Center on Stress & Health, University of California, Irvine, Irvine, CA, USA.
- Children's Hospital of Orange County, Orange, CA, USA.
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Martin SR, Heyming T, Kain AS, Krauss BS, Campos B. Eliminating pain disparities for children in the emergency department. Acad Emerg Med 2023; 30:1075-1077. [PMID: 36912795 PMCID: PMC10497707 DOI: 10.1111/acem.14723] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Sarah R. Martin
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, California, USA
- Center on Stress & Health, University of California, Irvine, California, USA
- Emergency Medicine, Children’s Hospital of Orange County, Orange, California, USA
| | - Theodore Heyming
- Emergency Medicine, Children’s Hospital of Orange County, Orange, California, USA
| | - Alexandra S. Kain
- Frank H. Netter School of Medicine, Quinnipiac University, Hamden, Connecticut, USA
| | - Baruch S. Krauss
- Division of Emergency Medicine, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Belinda Campos
- Chicano/Latino Studies, University of California, Irvine, California, USA
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Reich SM, Dahlin M, Tulagan N, Kerlow M, Cabrera N, Piroutek MJ, Heyming T. Caregivers' Experiences During the COVID-19 Pandemic and Their Children's Behavior. J Fam Issues 2023; 44:1093-1112. [PMID: 36941899 PMCID: PMC10009501 DOI: 10.1177/0192513x211055511] [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] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has financial and emotional impacts on families. We explored how caregivers' financial strain and mental health are associated with changes in their young children's behavior during the pandemic. We additionally considered whether having a sense of purpose moderated these associations. Caregivers (n = 300) in the emergency department of a children's hospital were surveyed anonymously about changes to their employment (e.g., reduced/increased hours and job loss), ability to pay for expenses and whether their child's behavior had changed. Aligned with the Family Stress Model, caregivers' financial strain was associated with poor mental health, inconsistent sleep routines, and changes in children's problematic and prosocial behaviors. A sense of purpose buffered some of these relationships. Families are differently affected by the pandemic and our findings underscore the need for supporting caregivers' mental health and connecting them with resources.
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Affiliation(s)
| | - Melissa Dahlin
- UCI School of Education, University of California, Irvine, CA, USA
| | - Nestor Tulagan
- UCI School of Education, University of California, Irvine, CA, USA
| | | | | | | | - Theodore Heyming
- CHOC Children’s Hospital of Orange County, Orange, CA, USA
- Department of Emergency Medicine, University of California, Irvine, CA, USA
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Heyming T, Knudsen-Robbins C, Sharma S, Thackeray J, Schomberg J, Lara B, Wickens M, Wong D. Child physical abuse screening in a pediatric ED; Does TRAIN(ing) Help? BMC Pediatr 2023; 23:117. [PMID: 36894913 PMCID: PMC9998251 DOI: 10.1186/s12887-023-03927-0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/21/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Child maltreatment is distressingly prevalent yet remains under-recognized by healthcare providers. In 2015 the Ohio Children's Hospital Association developed the Timely Recognition of Abusive INjuries (TRAIN) collaborative in an effort to promote child physical abuse (CPA) screening. Our institution implemented the TRAIN initiative in 2019. The objective of this study was to examine the effects of the TRAIN initiative at this institution. METHODS In this retrospective chart review we recorded the incidence of sentinel injuries (SIS) in children presenting to the Emergency Department (ED) of an independent level 2 pediatric trauma center. SIS were defined and identified by a diagnosis of ecchymosis, contusion, fracture, head injury, intracranial hemorrhage, abdominal trauma, open wound, laceration, abrasion, oropharyngeal injury, genital injury, intoxication, or burn in a child < 6.01 months of age. Patients were stratified into pre-TRAIN (PRE), 1/2017-9/2018, or post-TRAIN (POST), 10/2019-7/2020, periods. Repeat injury was defined as a subsequent visit for any of the previously mentioned diagnoses within 12 months of the initial visit. Demographics/visit characteristics were analyzed using Chi square analysis, Fischer's exact test, and student's paired t-test. RESULTS In the PRE period, 12,812 ED visits were made by children < 6.01 months old; 2.8% of these visits were made by patients with SIS. In the POST period there were 5,372 ED visits, 2.6% involved SIS (p = .4). The rate of skeletal surveys performed on patients with SIS increased from 17.1% in the PRE period to 27.2% in the POST period (p = .01). The positivity rate of skeletal surveys in the PRE versus POST period was 18.9% and 26.3% respectively (p = .45). Repeat injury rates did not differ significantly in patients with SIS pre- versus post-TRAIN (p = .44). CONCLUSION Implementation of TRAIN at this institution appears to be associated with increased skeletal survey rates.
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Affiliation(s)
- Theodore Heyming
- Children's Health of Orange County, CHOC Hospital, 1201 W. La Veta Ave, Orange, CA, 92868, USA. .,Department of Emergency Medicine, University of California, Irvine, 3800 W. Chapman Ave, Suite 3200, Orange, CA, 92868, USA.
| | - Chloe Knudsen-Robbins
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA
| | - Supriya Sharma
- Division of General Pediatrics, Harbor-UCLA Medical Center, 1000 W Carson St, Torrance, CA, 90502, USA
| | - Jonathan Thackeray
- Department of Pediatrics, Dayton Children's Hospital, 1 Childrens Plaza, Dayton, OH, 45404, USA
| | - John Schomberg
- Children's Health of Orange County, CHOC Hospital, 1201 W. La Veta Ave, Orange, CA, 92868, USA
| | - Bryan Lara
- Children's Health of Orange County, CHOC Hospital, 1201 W. La Veta Ave, Orange, CA, 92868, USA
| | - Maxwell Wickens
- Children's Health of Orange County, CHOC Hospital, 1201 W. La Veta Ave, Orange, CA, 92868, USA
| | - Daphne Wong
- Children's Health of Orange County, CHOC Hospital, 1201 W. La Veta Ave, Orange, CA, 92868, USA
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Brukman S, Ferguson M, Zaky K, Knudsen-Robbins C, Heyming T. Child Maltreatment Education: Utilizing an Escape Room Activity to Engage Learners on a Sensitive Topic. JETEM 2023. [DOI: 10.5070/m58160094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Siembieda J, Heyming T, Padlipsky P, Young KD. Triple Versus Single Application of Lidocaine, Epinephrine, and Tetracaine for Laceration Repair in Children. Pediatr Emerg Care 2022; 38:e472-e474. [PMID: 35100752 DOI: 10.1097/pec.0000000000002631] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Lidocaine (4%), epinephrine (0.1%), and tetracaine (0.5%) topical gel (LET) is a safe and effective method of providing anesthesia for laceration repair. Some patients, however, require additional infiltrated local anesthetic. We sought to determine if 3 applications of LET 10 minutes apart (triple LET) result in lower pain scores with suturing than one application for 30 minutes (single LET). METHODS We performed a randomized single-blind controlled trial of pediatric emergency department patients 7 to 17 years old with simple lacerations requiring sutures. Patients received either triple or single LET, and the first suture was placed or attempted within 15 minutes of removing the LET. Visual analog pain score on a 100-mm scale was obtained by a blinded nurse. Pain scores between groups were compared using the Wilcoxon rank sum test. RESULTS Forty-eight patients were enrolled: 21 for single LET and 27 for triple LET. Mean visual analog pain scale (VAS) score for single LET patients was 16 (SD, 17; range, 0-48), and that for triple LET patients was 16 (SD, 24; range, 0-95), with the difference not significant at 0.37 (95% confidence interval, -11.9 to 12.6). There was no significant difference in requirement for additional anesthesia between single LET (4 of 21 [19%]) and triple LET (5 of 27 [19%]) patients. CONCLUSIONS Lidocaine (4%), epinephrine (0.1%), and tetracaine (0.5%) topical gel every 10 minutes for 3 applications was not superior in anesthetic efficacy to applying it once for 30 minutes.
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Affiliation(s)
- Joshua Siembieda
- From the Pediatric Emergency Medicine Faculty, Children's Hospital of Orange County, Orange
| | - Theodore Heyming
- From the Pediatric Emergency Medicine Faculty, Children's Hospital of Orange County, Orange
| | - Patricia Padlipsky
- David Geffen School of Medicine, University of California, Los Angeles, Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA
| | - Kelly D Young
- David Geffen School of Medicine, University of California, Los Angeles, Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA
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9
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Heyming T, Bacon K, Lara B, Knudsen-Robbins C, Tongol A, Sanger T. SARS-CoV-2 Serology Testing in an Asymptomatic, At-Risk Population: Methods, Results, Pitfalls. Infect Dis Rep 2021; 13:910-916. [PMID: 34698190 PMCID: PMC8544562 DOI: 10.3390/idr13040082] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022] Open
Abstract
The primary aim of this study was to determine the seroprevalence of SARS-CoV-2 antibodies in a population of pediatric healthcare workers (HCWs). This study was conducted 14 May-13 July 2020. Study participants included pediatric HCWs at a pediatric hospital with either direct patient contact or close proximity to patient-care areas. SARS-CoV-2 antibodies were assessed via the Wytcote Superbio SARS-CoV-2 IgM/IgG Antibody Fast Detection Kit and the Abbott Architect SARS-CoV-2 IgG assay. Participants underwent RT-PCR testing upon entry to the study and following rapid IgM+/IgG+ results; respiratory panel PCR (RP-PCR) was performed following IgM+ results. A total of 57 of 289 (19.7%) of participants demonstrated positive serology as assessed by the Wytcote rapid kit (12 on Day 1 and 45 throughout the study). However, only one of these participants demonstrated IgG+ serology via the Abbott assay. Two participants tested SARS-CoV-2+ via RT-PCR testing. One individual was adenovirus+ and enterovirus/rhinovirus+. In our study population, we observed a seroprevalence of SARS-CoV-2 antibodies of 0.35%. The lack of concordance between antibody tests suggests that the Wytcote rapid test kit may not be of use as a screening tool. However, the feasibility of the overall process indicates that a similar methodology may have potential for future epidemiologic surveillance.
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Affiliation(s)
- Theodore Heyming
- Children’s Hospital of Orange County, Orange, CA 92868, USA; (T.H.); (K.B.); (B.L.); (A.T.)
- Department of Emergency Medicine, University of California, Irvine, CA 92868, USA
| | - Kellie Bacon
- Children’s Hospital of Orange County, Orange, CA 92868, USA; (T.H.); (K.B.); (B.L.); (A.T.)
| | - Bryan Lara
- Children’s Hospital of Orange County, Orange, CA 92868, USA; (T.H.); (K.B.); (B.L.); (A.T.)
| | | | - Aprille Tongol
- Children’s Hospital of Orange County, Orange, CA 92868, USA; (T.H.); (K.B.); (B.L.); (A.T.)
| | - Terence Sanger
- Children’s Hospital of Orange County, Orange, CA 92868, USA; (T.H.); (K.B.); (B.L.); (A.T.)
- Department of Electrical Engineering and Computer Science, University of California, Irvine, CA 92697, USA
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10
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Sharma S, Wong D, Schomberg J, Knudsen-Robbins C, Gibbs D, Berkowitz C, Heyming T. COVID-19: Differences in sentinel injury and child abuse reporting during a pandemic. Child Abuse Negl 2021; 116:104990. [PMID: 33707071 PMCID: PMC8446928 DOI: 10.1016/j.chiabu.2021.104990] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/21/2021] [Accepted: 02/02/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES There is widespread concern that the COVID-19 pandemic has increased the incidence of child maltreatment. However, reports in the scientific literature documenting rates of child maltreatment during this period are scarce. This study was designed to explore whether the incidence of child maltreatment among patients presenting to a pediatric emergency department has increased during the COVID-19 pandemic. METHODS We conducted a retrospective review of patients of all ages presenting to a pediatric Emergency Department trauma center, who also had a child abuse report filing or a sentinel injury diagnosis related to their index visit. All such patients who presented to this institution from March through July of 2017 through 2020 were included in the study. RESULTS Analysis demonstrated an increase in the incidence of child maltreatment in May and June of 2020 and that there was an overall shift in distribution of types of child maltreatment during the COVID-19 pandemic. There was a significant increase in the proportion of emotional/psychological abuse (2.52 % before the pandemic to 7.00 % during the pandemic, p ≤ 0.0001) and non-medical neglect (31.5%-40.0%, p ≤ 0.0001). CONCLUSIONS We observed an increase in specific types of child maltreatment during the COVID-19 pandemic. These findings highlight the need for increased attention to children at risk for child abuse and neglect.
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Affiliation(s)
| | - Daphne Wong
- Children's Health of Orange County, Orange, CA, United States
| | - John Schomberg
- Children's Health of Orange County, Orange, CA, United States
| | | | - David Gibbs
- Children's Health of Orange County, Orange, CA, United States
| | | | - Theodore Heyming
- Children's Health of Orange County, Orange, CA, United States; Emergency Department, University of California, Irvine, United States.
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Ehwerhemuepha L, Heyming T, Marano R, Piroutek MJ, Arrieta AC, Lee K, Hayes J, Cappon J, Hoenk K, Feaster W. Development and validation of an early warning tool for sepsis and decompensation in children during emergency department triage. Sci Rep 2021; 11:8578. [PMID: 33883572 PMCID: PMC8060307 DOI: 10.1038/s41598-021-87595-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/30/2021] [Indexed: 11/09/2022] Open
Abstract
This study was designed to develop and validate an early warning system for sepsis based on a predictive model of critical decompensation. Data from the electronic medical records for 537,837 visits to a pediatric Emergency Department (ED) from March 2013 to December 2019 were collected. A multiclass stochastic gradient boosting model was built to identify early warning signs associated with death, severe sepsis, non-severe sepsis, and bacteremia. Model features included triage vital signs, previous diagnoses, medications, and healthcare utilizations within 6 months of the index ED visit. There were 483 patients who had severe sepsis and/or died, 1102 had non-severe sepsis, 1103 had positive bacteremia tests, and the remaining had none of the events. The most important predictors were age, heart rate, length of stay of previous hospitalizations, temperature, systolic blood pressure, and prior sepsis. The one-versus-all area under the receiver operator characteristic curve (AUROC) were 0.979 (0.967, 0.991), 0.990 (0.985, 0.995), 0.976 (0.972, 0.981), and 0.968 (0.962, 0.974) for death, severe sepsis, non-severe sepsis, and bacteremia without sepsis respectively. The multi-class macro average AUROC and area under the precision recall curve were 0.977 and 0.316 respectively. The study findings were used to develop an automated early warning decision tool for sepsis. Implementation of this model in pediatric EDs will allow sepsis-related critical decompensation to be predicted accurately after a few seconds of triage.
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Affiliation(s)
- Louis Ehwerhemuepha
- Children's Health of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA.
| | - Theodore Heyming
- Children's Health of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA
| | - Rachel Marano
- Children's Health of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA
| | - Mary Jane Piroutek
- Children's Health of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA
| | - Antonio C Arrieta
- Children's Health of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA
| | - Kent Lee
- Children's Health of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA
| | - Jennifer Hayes
- Children's Health of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA
| | - James Cappon
- Children's Health of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA
| | - Kamila Hoenk
- Children's Health of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA
| | - William Feaster
- Children's Health of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA
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Heyming T, Bosson N, Kurobe A, Kaji AH, Gausche-Hill M. Accuracy of Paramedic Broselow Tape Use in the Prehospital Setting. PREHOSP EMERG CARE 2012; 16:374-80. [DOI: 10.3109/10903127.2012.664247] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Youngquist ST, Niemann JT, Allread WG, Heyming T, Rosborough JP. Neurologically Intact Survival in a Porcine Model of Cardiac Arrest: Manual Cardiopulmonary Resuscitation vs. LifeBelt Cardiopulmonary Resuscitation. PREHOSP EMERG CARE 2010; 14:324-8. [DOI: 10.3109/10903121003770662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Youngquist ST, Heyming T, Rosborough JP, Niemann JT. Hypocalcemia following resuscitation from cardiac arrest revisited. Resuscitation 2010; 81:117-22. [PMID: 19913975 PMCID: PMC2815084 DOI: 10.1016/j.resuscitation.2009.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 08/11/2009] [Accepted: 10/02/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Hypocalcemia associated with cardiac arrest has been reported. However, mechanistic hypotheses for the decrease in ionized calcium (iCa) vary and its importance unknown. The objective of this study was to assess the relationships of iCa, pH, base excess (BE), and lactate in two porcine cardiac arrest models, and to determine the effect of exogenous calcium administration on post-resuscitation hemodynamics. METHODS Swine were instrumented and VF was induced either electrically (EVF, n=65) or spontaneously, ischemically induced (IVF) with balloon occlusion of the LAD (n=37). Animals were resuscitated after 7 min of VF. BE, iCa, and pH, were determined prearrest and at 15, 30, 60, 90, 120 min after ROSC. Lactate was also measured in 26 animals in the EVF group. Twelve EVF animals were randomized to receive 1g of CaCl(2) infused over 20 min after ROSC or normal saline. RESULTS iCa, BE, and pH declined significantly over the 60 min following ROSC, regardless of VF type, with the lowest levels observed at the nadir of left ventricular stroke work post-resuscitation. Lactate was strongly correlated with BE (r=-0.89, p<0.0001) and iCa (r=-0.40, p<0.0001). In a multivariate generalized linear mixed model, iCa was 0.005 mg/dL higher for every one unit increase in BE (95% CI 0.003-0.007, p<0.0001), while controlling for type of induced VF. While there was a univariate correlation between iCa and BE, when BE was included in the regression analysis with lactate, only lactate showed a statistically significant relationship with iCa (p=0.02). Post-resuscitation CaCl(2) infusion improved post-ROSC hemodynamics when compared to saline infusion (LV stroke work control 8+/-5 gm vs 23+/-4, p=0.014, at 30 min) with no significant difference in tau between groups. CONCLUSIONS Ionized hypocalcemia occurs following ROSC. CaCl(2) improves post-ROSC hemodynamics suggesting that hypocalcemia may play a role in early post-resuscitation myocardial dysfunction.
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Affiliation(s)
- Scott T Youngquist
- Department of Surgery, Division of Emergency Medicine, University of Utah Medical Center, 30 North 1900 East 1C026, Salt Lake City, UT 84132, United States.
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