Information System Database Research Articles

Sociodemographic predictors of imaging utilization in children with right lower quadrant pain.

Inequities in health care access lead to inequities in outcome. In recent years, health outcome disparities have been documented in children with acute appendicitis and sociodemographic predictors of imaging utilization have not been adequately assessed. The purpose of our study is to assess sociodemographic predictors for the diagnostic imaging of children with right lower quadrant (RLQ) pain. Our hypothesis is that disparities exist in imaging utilization. Our nationwide retrospective cohort study of the Pediatric Health Information System (PHIS) database queried emergency department encounters for children aged 0-18years presenting with RLQ pain (ICD code CM R10.31) between January 2018 and September 2023. Primary exposures included neighborhood-level sociodemographic metrics as measured by Child Opportunity Index, race/ethnicity, and insurance status. Outcomes included no diagnostic imaging, diagnostic imaging with radiography alone, ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). Multivariable logistic regression analyses assessed modality usage with respect to the primary exposures after controlling for demographic (age, gender) and additional (hospital geographic region, time of imaging) covariates. To avoid the perpetuation of bias, reference categories were determined by the lowest numerical value for each covariate. In total, 100,161 patient encounters met inclusion criteria (mean patient age 11.2years ± 3.9; 59.3%, n = 59,416 females). Imaging utilized was US (78.0%; n = 78,115), CT (16.4%, n = 16,405), no imaging (13.9%, n = 13,894), radiography alone (4.4%, n = 4,429), and MRI (3.1%, n = 3,148). The most predictive factors for no imaging were moderate, low, and very low Child Opportunity Index (aOR 1.25, 1.17, and 1.18 [95% CI 1.10-1.33] compared to very high Child Opportunity Index); Black race/ethnicity (aOR 1.26 [95% CI 1.11-1.44] compared to White or Asian race/ethnicity); and public or other insurance (aOR 1.23 and 1.32 [95% CI 1.18-1.41] compared to commercial insurance). The most predictive factors for radiography alone were Black race/ethnicity (aOR 1.30 [95% CI 1.17-1.45] compared to Hispanic race/ethnicity) and public or other insurance (aOR 1.26 [95% CI 1.11-1.44] compared to commercial). The most predictive factors for US were very-high Child Opportunity Index (aOR 1.16 [95% CI 1.09-1.22] compared to very low Child Opportunity Index); Asian, NH-White, or Hispanic race/ethnicity (aOR 1.33, 1.31, 1.30 [95% CI 1.18-1.40] compared to Black race/ethnicity); and commercial insurance (aOR 1.20 [95% CI 1.16-1.25] compared to public insurance). The most predictive factor for CT was White race/ethnicity (aOR 1.26 [95% CI 1.11-1.43] compared with Asian race/ethnicity) and the most predictive factor for MRI was Hispanic race/ethnicity (aOR 1.49 [95% CI 1.17-1.61] compared with Black race/ethnicity). The greatest predictor of cross-sectional imaging was a hospital's region, with CT most likely in southern hospitals (aOR 4.09 [95% CI 2.17-7.70] compared with northeast hospitals). Patient Child Opportunity Index did not predict the likelihood of cross-sectional imaging with CT or MRI in tertiary pediatric centers. Sociodemographic disparities exist in the imaging of children presenting to tertiary pediatric hospitals with RLQ pain. Future studies are needed to analyze the causes of such disparities both on hospital and departmental levels.

A Comparison of Pediatric Prehospital Opioid Encounters and Social Vulnerability

ABSTRACT OBJECTIVES This study explores the relationship between socioeconomic factors and pediatric opioid-related emergencies requiring naloxone administration in the prehospital setting, an escalating public health concern. METHODS A retrospective analysis of the National Emergency Medical Services Information System (NEMSIS) database was conducted, examining data from pediatric opioid-related EMS activations between January 2018 and December 2021. The Social Vulnerability Index (SVI) was used to gauge each incident's socioeconomic context and assess correlations between SVI scores and the likelihood of opioid-related activations and naloxone interventions. RESULTS A total of 7,789 pediatric opiate-related EMS activations were identified. Lower socioeconomic status (SES) areas (higher SVI scores) exhibited a decreased rate of opioid-related activations compared to lower SVI-scored areas but an increased frequency of naloxone administration. The analysis demonstrated that as socioeconomic status (SES) improves, the likelihood of opioid-related activations increases significantly supported by a significant negative linear trend (Estimate = -0.2971, SE = 0.1172, z = -2.54, p = 0.0112. On the other hand, naloxone administration was more frequently required in lower SES areas, suggesting an increased emergency response in these (Estimate = 0.05806, SE = 0.2403, z = 0.24, p = 0.8091). CONCLUSIONS The analysis highlights a statistically significant correlation between the SES of an area and pediatric opioid-related EMS activations, yet an inverse correlation with the likelihood of naloxone administration. These findings demonstrate that in lower socioeconomic areas, the total number of opiate-related EMS activations is lower; however, naloxone was more likely to be deployed during those activations. This underscores the need for further research to understand the disparities in opioid crisis management across different socioeconomic landscapes.

Implications for Paleontological Heritage Conservation: The Spatial Distribution and Potential Factors Controlling the Location of Fossil Sites of Shandong Province in China

Shandong Province in China is rich in paleontological fossils and has a long history of fossil research. However, research on the distribution characteristics and potential factors of discovered fossil sites in Shandong Province is limited and insufficient, making it difficult to comprehensively plan for the protection and utilization of fossil sites in Shandong Province. The study constructs a basic geographical information system (GIS) database with 133 discovered fossil sites and geological and socio-economic data of Shandong Province and studies fossil sites’ spatial distribution characteristics and the spatial relationship with potential factors at a regional scale. The results are as follows: (1) The fossil sites in Shandong Province are concentrated in the mountainous area of central Shandong and the hilly area of the Shandong Peninsula, with significant uneven distribution characteristics, including two agglomeration areas and seven sub-agglomeration areas. (2) Natural geographical conditions, such as topography, paleogeography, and stratigraphy, play a positive role in the distribution of fossil sites, and there are apparent concentrations in the following areas: at an altitude greater than 100 m; the Lower Paleozoic and Cretaceous sedimentary rocks; and the active areas of paleo-tectonics. (3) A certain degree of negative correlation exists between socio-economic conditions, such as roads and population density, and the number of fossil sites, and a positive correlation exists between disposable personal income and those fossil sites. The operational procedure presented here is a simple, objective, applicable method that can enhance our understanding of the spatial distribution patterns and influencing factors of the discovered fossil sites of Shandong Province and support more effective and appropriate planning for paleontological heritage conservation.

Comorbidities, pharmacologic interventions, and mechanical interventions associated with mortality in isolated diastolic left heart failure: lessons from a national database.

Diastolic heart failure may be noted in paediatric patients with CHD, cardiomyopathy, or malignancies requiring chemotherapy, but the available data are scarce, and often derived from adult trials or based on theoretic or anecdotal evidence. Data between 2016 and 2021 were obtained from Pediatric Health Information System database. Patients <18 years of age with isolated diastolic heart failure admitted to ICU at some point during admission were included. They were divided into patients with and without inpatient mortality. Patients' demographics, comorbidities using ICD-10 codes, and pharmacologic interventions were also recorded. Univariate analysis was done in demographics, comorbidities, pharmacologic interventions, and mechanical interventions between admissions with and without mortality. Multivariable logistic regression was done for inpatient mortality and multivariable linear regression was done for total hospital length of stay in survivors. Isolated diastolic heart failure comprised 0.5% of critically ill paediatric patients. A total of 121 (5%) experienced mortality among the 2,273 admissions in the final analyses. Milrinone and angiotensin converting enzyme inhibitor were found to be associated with decreased mortality. Increasing age and diuretics were associated with decreased total hospital length of stay in survivors. In the cohort studied, isolated diastolic left heart failure has a 5% mortality. Several comorbidities and interventions are associated with increased mortality with milrinone and angiotensin converting enzyme inhibitors being associated with decreased risk of mortality. When only admissions with survival to discharge are considered, older age and diuretics are associated with lower total hospital length of stay.

Risk Factors and Outcomes of Perioperative Extracorporeal Membrane Oxygenation in Neonates and Infants Undergoing Truncus Arteriosus Repair.

Background: Despite surgical advances, neonatal truncus arteriosus repair remains high risk and approximately 10% of patients receive perioperative extracorporeal membrane oxygenation (ECMO). We aimed to assess factors and outcomes associated with the use of perioperative ECMO in infants undergoing truncus arteriosus repair. Methods: We conducted a retrospective cohort study of patients who underwent truncus arteriosus repair between 2004 and 2019, using administrative data from the Pediatric Health Information System database. Results: We identified 1,645 neonates and infants who underwent truncus arteriosus repair at 49 centers, of which 141 (8.6%) received ECMO. Prematurity (adjusted odds ratio [aOR], 2.06; 95% CI, 1.38-3.06; P < .001), truncal valve intervention (aOR, 4.69; 95% CI, 2.56-8.59; P < .001), and interrupted aortic arch repair (aOR, 1.80; 95% CI, 0.96-3.38; P = .07) were associated with perioperative ECMO. Hospital mortality occurred in 87 of 141 (62%) patients who received ECMO compared with 77/1504 (5.1%) who did not require ECMO(aOR, 13.39; 95% CI, 8.70-20.61; P < .001). In the 1,481 patients who survived to hospital discharge, ECMO was associated with higher rates of postoperative length of stay >30 days (63% [34/54] vs 28% [400/1427]; aOR 2.65; 95% CI, 1.24-5.64, P = .012) and hospital readmission within 90 days (61% [33/54 [ vs 33% [474/1427] [; aOR, 2.66; 95% CI, 1.47-4.82; P = .001). Conclusions: Prematurity, truncal valve intervention, and interrupted aortic arch repair are important risk factors that could help predict the use of perioperative ECMO. Extracorporeal membrane oxygenation utilization is strongly associated with greater odds of hospital mortality, prolonged postoperative length of stay, and higher rates of hospital readmission in surviving patients.

Management and outcomes of acute appendicitis in children with congenital heart disease.

Congenital heart disease (CHD) care has evolved during the past decades. Advances in care have contributed to improved survival among CHD patients. Children with CHD are requiring interventions for non-CHD related medical issues that occur in the general pediatric population. A retrospective review of the Pediatric Health Information System (PHIS) database from January 1, 2004, to July 31, 2023. Discharges of patients with an admitting/principal diagnosis of appendicitis were evaluated and categorized as CHD or non-CHD. A total of 319,228 patients were identified with 1,25,858(39.4%) female, 1,38,966(43.5%) white, and median age of 11[IQR:8-14] years. 708(0.2%) had CHD with 85(12%) of them having a diagnosis consistent with single-ventricle CHD (SV-CHD). In univariate analysis, CHD patients were more likely to undergo conservative treatment (n = 172(24.2%)vs n = 59,358(18.6%)) and less likely to undergo laparoscopic appendectomy (n = 483(68.2%) vs n = 2,35,324(73.8%))(p < 0.001) compared to non-CHD. After adjustment, CHD patients had increased odds of undergoing open appendectomy compared to non-CHD. CHD patients were more likely to have an ICU admission (OR:8.36(95%CI 6.35-10.00),p < 0.001) and had a 77.6%(95%CI 40.89-123.93) increase in length of stay (LOS) (p < 0.001). CHD patients are more likely to have an open appendectomy than non-CHD patients. These findings suggest a distinctive pattern in the care of CHD patients compared to non-CHD. Overall, CHD patients had a more intense level of care with longer LOS and increased ICU admissions. Further work is needed to evaluate drivers of management decisions, the role of conservative treatment with antibiotics alone in the CHD population, and the potential impacts and safety of a laparoscopic approach.

Outcomes in Pediatric Cholesteatoma.

The objective of the study is to evaluate the outcomes of surgical management options for cholesteatoma using a national database. Database analysis of the Pediatric Health Information System database to identify children undergoing surgical intervention for cholesteatoma from October 2015 to December 2022. Patients were categorized by initial surgical modality: tympanoplasty (TM), tympanoplasty with canal wall-up tympanomastoidectomy (TM-CWU), and tympanoplasty with canal wall-down tympanomastoidectomy (TM-CWD). Group comparisons were done on number of surgical revisions and number of patients identified with recommendations for hearing aids. A total of 6304 patients were identified in the database who underwent surgery for cholesteatoma. Of these children, 3405 underwent TM (54.0%), 3116 underwent TM-CWU (49.4%), and 825 underwent TM-CWD (8.2%). The estimated difference in mean number of procedures was significantly higher in the TM-CWU group compared to TM-CWD (-0.34, 95% confidence interval [CI] -0.406,-0.279, P < .0001) and the TM group (9.352, 95% CI 0.315, 0.390, P < .0001). The rate of significant hearing loss necessitating hearing aids was significantly lower in the TM group, but there was no difference between the TM-CWU and TM-CWD groups (1.2%, P < .03, 1.9% vs 2.7%, P = .13). There was no difference in the number of speech delays/therapy diagnoses between TM and TM-CWU or TM-CWU and TM-CWD (3.5%vs 4.4% P = .07, 4.4% vs 5.2%., P = .38). TM and TM-CWD had lower total surgical procedures than the TM-CWU group, and the TM group had a lesser rate of recommendation for hearing aids. The difference between number of procedures is likely due to the complexity of the disease; for instance, TM was likely chosen for small, less severe disease cases, whereas TM-CWD was chosen as more definitive treatment in aggressive cases. TM-CWD is associated with a lower rate of recidivism and recurrence, which also likely contributed to the lower number of procedures.

Effect of Management Information System on Growth of Agro-Firms in Anambra State

The study examined the effect of management information systems on the growth of agro-firms in Anambra State. The objectives were to: determine the effect of decision-making information systems on the Return on Investment (ROI) of agro-businesses in Anambra State, Nigeria, and ascertain the extent to which database management systems affect the ROI of agro-businesses in Anambra State, Nigeria. The study adopted a survey research design, with data generated from both primary and secondary sources. The data collection method was a questionnaire, which was randomly administered to staff of selected agro-firms. The population of the study was 6,727, while the sample size was 1,293, out of which 929 questionnaires were retrieved. The hypotheses were tested using the multiple regression analysis method at a 0.05% level of significance. The findings revealed that decision-making information systems had a significant effect on the ROI of agro-businesses in Anambra State, with a t-statistic of 7.743 and a probability value of 0.000. Additionally, database information systems had a significant effect on the ROI of agro-businesses in Anambra State, with a t-statistic of 2.476 and a probability value of 0.013. The study concluded that management information systems have a significant positive effect on agro-firms in Anambra State. It recommended that agricultural firms should invest in advanced decision support tools to aid data-driven decisions that maximize ROI. Furthermore, agro-business managers should focus on optimizing their database information systems to improve data organization and accessibility. Regular maintenance and updates of the database systems are crucial for ensuring accurate and timely information, which can positively impact ROI.

Post Artesunate Delayed Hemolysis in Pediatric Patients in the United States

Abstract Background Malaria continues to pose a major threat to global public health, causing millions of infections and hundreds of thousands of deaths each year. Intravenous artesunate is the current first line therapy for severe malaria and has substantially reduced its mortality. Some patients develop severe delayed hemolysis after artesunate therapy, a phenomenon termed post artesunate delayed hemolysis (PADH). A recent study of U.S. adults treated with artesunate found that 2.7% of patients experienced PADH and 56% of those patients required blood transfusion. Thus, the U.S. Food and Drug Administration recommends that patients treated with artesunate receive weekly post-treatment monitoring of hemoglobin and hemolytic markers for four weeks after therapy. While PADH in adults frequently requires blood transfusion, the frequency and severity of PADH in pediatric patients in non-endemic countries is not known. Understanding the risk of PADH in pediatric patients is essential to determine appropriate monitoring for this condition. Methods Multicenter Retrospective Chart Review To estimate rates of PADH in pediatric patients (0-18 years of age), we used ICD-10 diagnosis codes to identify patients treated for malaria at seven hospitals (The Children’s Hospital of Philadelphia, Riley Hospital for Children, Texas Children’s Hospital, Seattle Children’s Hospital, UCSF Benioff Children’s Hospital, NYU Langone Medical Center, and Bellevue Hospital), between April 2017 and July 2022. We reviewed post-discharge laboratory values and clinic visits to identify patients with laboratory findings of PADH and determine clinical outcomes. Pediatric Health Information System (PHIS) Database Review To estimate rates of severe PADH requiring repeat emergency room visit or hospitalization, we used ICD-10 diagnosis codes to identify patients who were treated for malaria with artesunate between January 2019 and July 2023 in a database of 49 children’s hospitals (PHIS). We reviewed patient visits within eight weeks of treatment to identify patients with repeat presentations related to anemia or hemolysis. Results In our retrospective chart review, four of seventeen patients (25%) treated with artesunate had laboratory evidence of PADH. None of these patients were symptomatic and none required readmission or medical intervention. Haptoglobin levels remained low in most patients up to four weeks after treatment, regardless of the presence of PADH, and lactate dehydrogenase (LDH) levels slowly declined over this period. We identified 92 patients in the PHIS database who were treated with artesunate. Of these, three patients (3.3%) had a repeat presentation within four weeks with one or more diagnosis suggestive of new onset anemia. Repeat presentations occurred 5-13 days after initial admission for malaria. Conclusion PADH is common in US pediatric patients treated with artesunate for severe malaria. However, severe hemolysis requiring repeat emergency room visit or readmission is rare. We find that haptoglobin and LDH levels were not useful as initial screening labs for PADH in pediatric patients. Together, our findings call into question the utility of weekly laboratory monitoring, as opposed to symptom-based monitoring, to identify pediatric patients at risk of readmission for PADH. Additional studies are necessary to determine which patients would benefit from weekly laboratory monitoring and which can be monitored clinically.

Distribution of Specialties Providing Surgical Management of Cleft-Related Speech Disorders in Children 3 years of Age and Older: 2004 to 2021.

Given the overlap in specialties performing secondary correction of velopharyngeal incompetence (VPI), the present study investigated the specialty distribution for surgical providers of cleft care from 2004 to 2021. Data were obtained from 45 hospitals from 2004 to 2021 through the Pediatric Health Information System database. Cases of secondary surgical management of VPI were retrieved, identifying the year of surgery and specialty of the providing surgeon. A total of 7090 procedures were included in this study, of which 36.0% were secondary palatoplasty/lengthening, 34.1% were sphincter pharyngoplasty, and 29.8% were pharyngeal flap. Secondary management of VPI was performed by plastic surgeons (67%), otolaryngologists (31%), and oral and maxillofacial surgeons (OMFS, 12%). Palatal revision and/or lengthening procedures were the most common secondary procedure performed by plastic surgeons (42%) and OMFS (64%), whereas sphincter pharyngoplasty was the most common procedure performed by otolaryngologists (55%; P<0.001). The proportion of sphincter pharyngoplasty performed by plastic surgeons significantly decreased from 2017-2021 (P<0.05). Plastic surgeons performed most procedures for secondary management of VPI from 2004 to 2021, followed by otolaryngologists and OMFS. The type of procedure selected for secondary management of VPI differed significantly between the provider's specialty, with otolaryngologists more likely to perform sphincter pharyngoplasty.

Leaving Against Medical Advice From Children's Hospitals.

Leaving the hospital against medical advice (AMA) reflects a breakdown in the family-clinician relationship and creates ethical dilemmas in inpatient pediatric care. There are no national data on frequency or characteristics of leaving AMA from US children's hospitals. We performed a retrospective cohort study of hospital discharges for children under 18 years old from January 1, 2018 to December 31, 2022 in 43 children's hospitals in the Pediatric Health Information System (PHIS) database. The primary outcome was leaving AMA. Exposures were demographic, geographic, and clinical characteristics. We used multivariable mixed effects logistic regression models to assess independent factors associated with leaving AMA and all-cause 14-day hospital readmission. Among 3 672 243 included inpatient encounters, 2972 (0.08%) ended in leaving AMA. Compared with non-Hispanic white patients, non-Hispanic Black patients had higher odds of leaving AMA (adjusted odds ratio [aOR] 1.31 [95% confidence interval (CI) 1.19-1.44]), whereas Hispanic patients (aOR 0.66 [95% CI 0.59-0.75]) had lower odds of leaving AMA. Hospitalizations for patients with noncommercial insurance were more likely to end in leaving AMA. Leaving AMA was associated with increased odds of 14-day inpatient readmission (aOR 1.41 [95% CI 1.24-1.61]) compared with patients who did not leave AMA. There was substantial interhospital variability in standardized rates of leaving AMA (range 0.18-2.14 discharges per 1000 inpatient encounters). Approximately 1 in 1235 inpatient encounters ended in leaving AMA. Non-Hispanic Black patients had increased odds of leaving AMA. Leaving AMA was associated with increased odds of 14-day readmission.

A Cross-Sectional Analysis of ALS/ BLS Care in Low Acuity 9-1-1 Response by Geography and Insurance Status Utilizing the 2019 NEMSIS Dataset

Purpose. The objective of this study was to examine the relationship between patient acuity and level of EMS care adjusting for rurality and insurance. Methods. Data were obtained from the National Emergency Services Information System (NEMSIS) database for 2019. EMS responses (n = 4,375,568) were analyzed comparing patient acuity and CMS Service level, Advanced Life Support (ALS) vs Basic Life Support (BLS), to assess for associations in acuity and CMS Service level using logistic regression. Results. Overall, there was a decreased odds of advanced life service use at low acuity EMS responses (OR=0.443, 95% CI=0.440-0.445). Sub analysis exploring the interaction between CMS Service Level, Rurality demonstrates an overall trend of decreasing odds of low acuity EMS responses among rural areas and BLS care (OR=0.492, 95% CI=0.486,0.498) and ALS care (OR=0.198, 95% CI=0.197,0.200). When analyzing trends among public vs all other insurance and rural vs urban settings, there were decreases in low acuity ALS care in the rural setting; ALS and Pub Insurance (OR 0.447, 0.444-0.450, p&lt;0.001), ALS and Rural (OR 0.198, CI 0.197-0.914, p&lt;0.001) among low acuity responses. The results indicate that acuity and service level vary according to insurance and rurality. In the low acuity call type, we see decreased odds of ALS use compared BLS use in those with public insurances compared to other insurance. There is also a geographic component to these results where the use of Advance Life Support services declined with decreases in urbanicity. Discussion. These results potentially highlight that rural areas utilize less emergency medical response resources in low acuity responses. As such, EMS programs like community paramedicine, could be potentially effective interventions to close gaps in access to care for rural residents.

A-071 Macroprolactin Screening in Patients with Hyperprolactinemia: Comparison Between Different Criteria for Defining Macroprolactinemia

Abstract Background Prolactin (PRL) exists in different forms in human serum. The predominant form is monomeric PRL, the other forms include dimeric PRL and polymeric PRL, also known as macroprolactin, a biologically inactive form. Macroprolactin can be measured by almost all immunoassays for PRL. This may lead to misdiagnosis and mismanagement of patients. Polyethylene glycol (PEG) precipitation is the most widely used method for detecting macroprolactin, generally employing a cutoff of 40% to distinguish macroprolactinemia from true hyperprolactinemia. This approach lacks specificity, so the reported result may be misinterpreted in cases in which excess macroprolactin occurs simultaneously with supraphysiological concentrations of monomeric prolactin. Nowadays, it is recommended to report results as post-PEG PRL using method-specific post-PEG reference intervals, classifying as macroprolactinemia (false or pseudohyperprolactinemia) those individuals with post- PEG PRL within post-PEG reference intervals and true hyperprolactinemia above the upper limit of the post-PEG reference interval. The objective of this study was to evaluate the prevalence of macroprolactinemia in patients with hyperprolactinemia using two different criteria, a cutoff &amp;lt; 40% in PEG precipitation and a post- PEG PRL within post-PEG assay specific reference range. Methods We analyzed blood samples requesting serum macroprolactin from patients admitted to a private reference clinical laboratory in Rio de Janeiro, Brazil, from 01/01/2019 to 12/31/2023. Anonymized data on laboratory tests was available from a database of the local Laboratory Information System. All patients included had PRL levels above the reference range, males &amp;gt;15.2 ng/mL, females &amp;gt;23.3 ng/mL (ECLIA, Modular, Roche). Results 9423 patients, 80.1% women (W) were evaluated. Men (M) were statistically significantly older than women (p&amp;lt;0.001) (45.6; SD=15.0 vs. 38.9; SD=11.5). Prolactin median levels were significantly higher in women (p&amp;lt;0.001) than men (37.4ng/mL, IQR=26 vs. 23.8ng/mL, IQR=17.1). Macroprolactinemia detection was greater (p&amp;lt;0.001) by post-peg PRL concentration criteria (9.7% - 10.1%W vs. 8.4%M), than by &amp;lt; 40% PRL recovery criteria (5.5% - 5.7%W vs. 4.8%M). Dividing patients by prolactin levels (&amp;lt;50.0; 50.0 to &amp;lt;100.0; 100.0 to &amp;lt;150.0, &amp;gt;150.0 ng/mL, we found macroprolactinemia in 5.2% (5.2%W vs. 5.2%M), 7.7% (8.2%W vs. 2.4%M), 2.8% (2.8%W vs. 2.5%M) and 1.6% (1.3%W vs. 2.6%M) - &amp;lt;40% PRL recovery criteria; and 12.1% (12.8%W vs. 9.8%M), 4.4% (4.8%W vs. 0.6%M), 0.8% (0.8%W vs. 0%M), 0.0% (0%W vs. 0%M) - post-PEG PRL concentration criteria. By the last criteria, no patient with total PRL more than 150 ng/mL had macroprolactinemia. Conclusions The criterion for defining macroprolactinemia has a big impact on the study results and needs to be considered in data interpretation and comparison with other studies. PEG precipitation is an easy and fast screening method for macroprolactin. Its main purpose should be determining whether the bioactive monomeric prolactin concentration is increased which is why the post-PEG PRL with corresponding reference interval is the most suitable way of reporting results.

Younger and rural children are more likely to be hospitalized for SARS-CoV-2 infections.

To identify characteristics of SARS-CoV-2 infection that are associated with hospitalization in children initially evaluated in a Pediatric Emergency Department (ED). We identified cases of SARS-CoV-2 positive patients seen in the Arkansas Children's Hospital (ACH) ED or hospitalized between May 27, 2020, and April 28, 2022, using ICD-10 codes within the Pediatric Hospital Information System (PHIS) Database. We compared infection waves for differences in patient characteristics and used logistic regressions to examine which features led to a higher chance of hospitalization. We included 681 pre-Delta cases, 673 Delta cases, and 970 Omicron cases. Almost 17% of patients were admitted to the hospital. Compared to Omicron-infected children, pre-Delta and Delta-infected children were twice as likely hospitalized (OR = 2.2 and 2.0, respectively; p<0.0001). Infants under one year were >3 times as likely to be hospitalized than children ages 5-14 years regardless of wave (OR = 3.42; 95%CI = 2.36-4.94). Rural children were almost three times as likely than urban children to be hospitalized across all waves (OR = 2.73; 95%CI = 1.97-3.78). Finally, those with a complex condition had nearly a 15-fold increase in odds of admission (OR = 14.6; 95%CI = 10.6-20.0). Children diagnosed during the pre-Delta or Delta waves were more likely to be hospitalized than those diagnosed during the Omicron wave. Younger and rural patients were more likely to be hospitalized regardless of the wave. We suspect lower vaccination rates and larger distances from medical care influenced higher hospitalization rates.

A combined method for the evaluation of contributing factors to maritime dangerous goods transport accidents

This paper evaluates the contributing factors to maritime dangerous goods (DG) transport accidents by integrating the Entropy Weight (EW) and Grey Relational Analysis (GRA) methods. For this purpose, investigation reports of maritime DG transport accidents that occurred worldwide between 2000 and 2023 are derived from the International Maritime Organization’s Integrated Shipping Information System (IMO GISIS) database’s Marine Casualties and Incidents (MCI) module. Eleven main ship operations and thirteen primary causes were selected by analysing accident investigation reports. The weights of main ship operations are calculated utilizing the EW method. The correlational degrees of the primary causes are then calculated using the GRA method. Most maritime DG transport accidents occur during unberthing, bunkering, and pilotage operations. The most common contributing factors of maritime DG transport accidents are collisions and occupational accidents. Specifically, maritime DG transport accidents are most likely to be caused by collisions during sailing, passage, maneuvering, and bunkering operations, as well as occupational accidents during cargo loading, anchoring, berthing, and mooring operations. The results of this paper can support stakeholders in developing the needed policies to guarantee the safety of maritime DG transport.

Trends in the Diagnosis of Pediatric Venous Thromboembolism and Arterial Ischemic Stroke during the COVID-19 Pandemic: An Administrative Database Study

To investigate trends in the diagnosis of venous thromboembolism (VTE) and arterial ischemic stroke (AIS), and examine the use of pharmacological thromboprophylaxis during the COVID-19 pandemic. This retrospective cohort study used the Pediatric Health Information Systems database to investigate patients admitted to a participating hospital between January 1, 2018, and December 31, 2021. International Classification of Diseases, 10th edition codes were used to identify VTE, AIS, and COVID-19. Pharmacy billing codes were used to investigate pharmacological thromboprophylaxis use. 1 759 701 unique patients underwent 2 234 135 inpatient admissions. Rate of VTE increased from 84 cases per 10 000 admissions in 2018-2019 to 108 cases per 10 000 admissions in 2020-2021, representing a 28.6% increase (P<.001). In contrast, the rate of AIS remained stable through the study period. When compared with 2018-2019, children diagnosed with VTE during 2020-2021 had longer hospitalizations and were more likely to be admitted to the intensive care unit. When analysis was limited to 2020-2021, a diagnosis code of COVID-19 was associated with a 1.35-fold (95% CI: 1.24-1.45) increase in the odds of VTE diagnosis, but not AIS. Use of pharmacologic thromboprophylaxis increased from 1.5% of hospitalizations in 2018-2019 to 3.0% of hospitalizations in 2020-2021 (P<.001). When evaluating thromboprophylaxis during 2020-2021, a diagnosis code for COVID-19 was associated with an 11-fold (95% CI: 10.86-11.49; P<.001) increase in the utilization of pharmacological thromboprophylaxis. This study found an increase in the rate of VTE among hospitalized children during the pandemic. A diagnosis of COVID-19 was associated with a modest increase in odds of VTE diagnosis, which occurred despite increased use of pharmacological thromboprophylaxis.

An update of the severe trauma scoring system using the Korean National Emergency Department Information System (NEDIS) database

BackgroundVarious scoring systems are utilized to assess severe trauma patients, with one of the most commonly used tools being the International Classification of Diseases Injury Severity Score (ICISS) criteria derived from the Survival Risk Ratio (SRR) calculated using diagnostic codes. This study aimed to redefine the severe trauma scoring system in Korea based on the SRR for diagnostic codes, and subsequently evaluate its performance in predicting survival outcomes for trauma patients. MethodsThis study included trauma patients who visited Level 1 and 2 emergency departments (EDs) between January 2016 and December 2019, utilizing the Korean National Emergency Department Information System (NEDIS) database. The primary outcome of this study was in-hospital mortality. The new SRR-2020 value was calculated for each of the 865 trauma diagnosis codes (Korean Standard Classification of Diseases [KCD-7] codes, 4-digit format), and the patient-specific ICISS-2020 value was derived by multiplying the corresponding SRR-2020 value based on patient diagnosis. We compared the predictive performance for in-hospital mortality between severe trauma patients with an ICISS <0.9 based on the newly developed ICISS-2020 version and those defined by the previously used ICISS-2015 version. ResultsA total of 3,841,122 patients were enrolled, with an in-hospital mortality rate of 0.5 %. Severe trauma patients with ICISS-2020 < 0.9 accounted for 5.3 % (204,897 cases) that was lower than ICISS-2015 < 0.9 accounting for 15.3 % (587,801 cases). Among the 20,619 in-hospital mortality cases, 81.4 % had ICISS-2020 < 0.9, and 88.6 % had ICISS-2015 < 0.9. When comparing predictive performance for in-hospital mortality between the two ICISS versions, ICISS-2020 showed higher accuracy (0.95), specificity (0.95), positive predictive value (PPV) (0.08), positive likelihood ratio (LR+) (16.53), and area under the receiver operating characteristic curve (AUROC) (0.96) than ICISS-2015 for accuracy (0.85), sensitivity (0.88), specificity (0.85), PPV (0.03), LR+ (5.94), and AUROC (0.94). However, regarding sensitivity, ICISS-2020 < 0.9 showed a lower value of 0.81 compared to ICISS-2015 < 0.9, which was 0.88. The negative predictive value (NPV) was 1.00 for both versions. ConclusionsThe newly developed ICISS-2020, utilizing a nationwide emergency patient database, demonstrated relatively good performance (accuracy, specificity, PPV, LR+, and AUROC) in predicting survival outcomes for patients with trauma.

Increased Emergency Department Identification of Young People Experiencing Trafficking During the COVID-19 Pandemic: An Interrupted Time-Series Analysis.

Human trafficking is a public health issue affecting young people across the United States, and trafficked young people frequently present to emergency departments (EDs). The identification of trafficked young people by pediatric EDs during the COVID-19 pandemic is not well understood. We examined trends in the identification of young people with current or lifetime experiences of trafficking in US pediatric EDs before and during the COVID-19 pandemic. We performed an interrupted time-series analysis using the Pediatric Health Information System database, which includes data from 49 US children's hospitals, to determine differences in rates of trafficked young people identified in pediatric EDs before and during the COVID-19 pandemic. We included 910 patients; 255 prepandemic (October 1, 2018, through February 29, 2020) and 655 during the COVID-19 pandemic (March 1, 2020, through February 28, 2023). We found a 1.92-fold increase in the incidence rate of identified trafficked young people at the start of the COVID-19 pandemic in March 2020 (incidence rate ratio = 1.92; 95% CI, 1.47-2.51; P < .001), followed by a decrease over time. The observed increase in identified trafficked young people during the onset of the COVID-19 pandemic should alert pediatric ED providers to the opportunity to identify and provide services for trafficked young people as an important part of improving preparedness for future disease outbreaks. Our observed identification trends do not represent the true incidence of trafficked young people presenting to pediatric EDs during the COVID-19 pandemic. Future work should seek to better understand the true occurrence and the health and service needs of trafficked young people during emergencies.

Comparing MLR and ANN models for school building electrical energy prediction in Osijek-Baranja County in Croatia

This paper presents a study conducted in Osijek-Baranja County, Croatia, to predict electrical energy consumption in school buildings. Data from the Energy Management Information System (EMIS) database for primary and secondary schools were analyzed using Multiple Linear Regression (MLR) and Artificial Neural Networks (ANN). The ANN model achieved a high R² of 0957 in the training set, with lower Mean Squared Error (MSE) and Root Mean Squared Error (RMSE) than the MLR model, which had an R² of 0950. On the validation set, the ANN model maintained an R² of 0954 and showed slightly better performance with a lower Coefficient of Variation of RMSE (CVRMSE) of 19,79 %, compared to the MLR model’s CVRMSE of 20,50 %. These results indicate that the ANN model generally provides more accurate and reliable predictions for energy consumption in school buildings. However, both models provided a robust positive correlation between the predicted and actual values.

Development and Evaluation of an Automated Protocol Recommendation System for Chest CT Using Natural Language Processing With CLEVER Terminology Word Replacement.

Purpose: To evaluate the clinical performance of a Protocol Recommendation System (PRS) automatic protocolling of chest CT imaging requests. Materials and Methods: 322 387 consecutive historical imaging requests for chest CT between 2017 and 2022 were extracted from a radiology information system (RIS) database containing 16 associated patient information values. Records with missing fields and protocols with <100 occurrences were removed, leaving 18 protocols for training. After freetext pre-processing and applying CLEVER terminology word replacements, the features of a bag-of-words model were used to train a multinomial logistic regression classifier. Four readers protocolled 300 clinically executed protocols (CEP) based on all clinically available information. After their selection was made, the PRS and CEP were unblinded, and the readers were asked to score their agreement (1 = severe error, 2 = moderate error, 3 = disagreement but acceptable, 4 = agreement). The ground truth was established by the readers' majority selection, a judge helped break ties. For the PRS and CEP, the accuracy and clinical acceptability (scores 3 and 4) were calculated. The readers' protocolling reliability was measured using Fleiss' Kappa. Results: Four readers agreed on 203/300 protocols, 3 on 82/300 cases, and in 15 cases, a judge was needed. PRS errors were found by the 4 readers in 1%, 2.7%, 1%, and 0.7% of the cases, respectively. The accuracy/clinical acceptability of the PRS and CEP were 84.3%/98.6% and 83.0%/99.3%, respectively. The Fleiss' Kappa for all readers and all protocols was 0.805. Conclusion: The PRS achieved similar accuracy to human performance and may help radiologists master the ever-increasing workload.