Pediatric Program Research Articles

Cased-based education rounds-the eternal heart of an international training program.

Case-based teaching or "Morning Rounds" have been used in medical education for more than a century and remain a cornerstone for teaching in many training programs. Our Pediatric Critical Care Medicine (PCCM) program was established forty years ago and has retained this form of teaching since its inception. Case-based rounds have consistently had the highest evaluation of all curricula in our program. Here we review the history of how these rounds were introduced in medical education, provide data from the learners' evaluation of these case-based rounds, and discuss the strengths and potential drawbacks of this form of teaching from an educational theories perspective with the hope that they can be used by other Pediatric Critical Care training programs.

Exploring The Interplay of Stunting and Upper Respiratory Infection in Kronjo Health Center: A Cross-Sectional Study

Background: Stunting, a prevalent form of chronic malnutrition, presents a significant public health challenge globally, particularly in low-income nations like Indonesia. This study investigates the prevalence and interaction of stunting and upper respiratory infections (URIs) among toddlers aged 12-59 months in Kronjo Health Center, a rural health center in West Java.
 Methods: Employing a cross-sectional design with total sampling, data were collected from October to November 2023. Height measurements were interpreted according to WHO child growth standards, and statistical analysis was performed using the Pearson chi-square 2x2 test.
 Results: The study involved 146 toddlers, with the majority being female (52.7%) and aged 12-23 months (34.9%). Most mothers had a high school education (39.7%), practiced breastfeeding (67.8%), and participated in basic pediatric immunization programs (61%). Additionally, 15 toddlers (10.3%) had a history of low birth weight, and a significant proportion were exposed to household smoking (n = 122; 83.6%) and lived in crowded households with six or more family members (n = 45; 30.8%). The study revealed a stunting prevalence of 46.6% and a URI prevalence of 63% among toddlers aged 12-59 months in Kronjo Health Center. Statistical analysis indicated a significant association between stunting and URIs (p-value = 0.035).
 Conclusion: This study highlights a significant association between stunting and URI among toddlers aged 12-59 months in Kronjo Health Center, emphasizing the importance of addressing both conditions in rural health settings.

Self-transfers, Hospital Admissions and Mortality Among Children and Adolescents Lost to Follow-up From Antiretroviral Therapy Programs in the Western Cape, South Africa Between 2004 and 2019: Linkage to Provincial Records.

Pediatric programs face a high rate of loss to follow-up (LTFU) among children and adolescents living with HIV (CAHIV). We assessed true outcomes and predictors of these among CAHIV who were LTFU using linkage to the Western Cape Provincial Health Data Centre at Western Cape sites of the International epidemiology Databases to Evaluate AIDS-Southern Africa collaboration. We examined factors associated with self-transfer, hospital admission and mortality using competing risks regression in a retrospective cohort of CAHIV initiating antiretroviral therapy <15 years old between 2004 and 2019 and deemed LTFU (no recorded visit at the original facility for ≥180 days from the last visit date before database closure and not known to have officially transferred out or deceased). Of the 1720 CAHIV deemed LTFU, 802 (46.6%) had self-transferred and were receiving care elsewhere within the Western Cape, 463 (26.9%) had been hospitalized and 45 (2.6%) CAHIV had died. The overall rates of self-transfer, hospitalization, mortality and LTFU were 9.4 [95% confidence interval (CI): 8.8-10.1], 5.4 (95% CI: 5.0-6.0), 0.5 (95% CI: 0.4-0.7) and 4.8 (95% CI: 4.4-5.3) per 100 person-years respectively. Increasing duration on antiretroviral therapy before LTFU was associated with self-transfers while male sex, older age at last visit (≥10 years vs. younger) were associated with hospital admission and immune suppression at last visit was associated with 5 times higher mortality. Nearly half of CAHIV classified as LTFU had self-transferred to another health facility, a quarter had been hospitalized and a small proportion had died.

Developing a General Population Screening Programme for Paediatric Type 1 Diabetes: Evidence from a Qualitative Study of the Perspectives and Attitudes of Parents

Introduction. With reliable tests and preventative treatments now available the United Kingdom has introduced a prototype population-based paediatric (ages 3–13) screening programme for type 1 diabetes (T1D). To aid its ethical and sustainable implementation this work explores parental views around the concept of this programme to determine how their involvement might be encouraged and supported. Research Design and Methods. Qualitative interviews were undertaken with 38 parents and the data were analysed using a purposely developed “Burden of Screening” framework, which presented the data within three domains describing the various elements of screening participation; pre-screening tasks designated to participants; factors influencing engagement with screening; and consequences of screening participation. Results. Regarding pre-screening tasks designated to participants, the importance of clear communication about the condition were apparent with parents expressing uncertainty of the benefits of screening against the potential anxiety engendered. In factors influencing their engagement with screening participants described their preference for less invasive testing techniques, the reassurance of structured support from healthcare professionals inherent within the programme, and the potential benefit of peer support. Regarding the consequences of screening participation parents described how a positive result might lead to overly protective behaviours, and anxiety from watching and waiting for the onset of symptomatic T1D. Conclusions. The benefits of T1D screening need to be clearly communicated to facilitate uptake. To this end the use of decision-support tools and better targeted educational materials should be explored. Post-testing, parents expressed preferences for peer support and access to psychological counselling.

Facility dog roles, responsibilities, and experiences in pediatric healthcare

ABSTRACT Current research indicates therapeutic benefits associated with facility dog interventions for hospitalized pediatric patients; however, considerably less is known about understanding, structuring, and optimizing these specialized services. Therefore, the purpose of this study was to describe the roles, responsibilities, and experiences of pediatric hospital-based facility dog teams and programs. Participants included 43 facility dog handlers employed in US pediatric healthcare settings. A survey collected information about handler and program characteristics, perceptions of the facility dog role, and intervention provision experiences. Most programs were found in freestanding children’s hospitals, serving inpatient units, ambulatory surgery, the emergency department, and radiology. They described facility dogs as highly trained, facility-specific animals that work in tandem with trained psychosocial support professionals to identify and meet patient- and family-focused goals. Participants reported a spectrum of psychosocial interventions, describing their work as primarily animal-assisted therapy, with some animal-assisted intervention and animal-assisted activities as well. Facility dogs, alongside their handlers, offer an array of interventions grounded in their assessment of a child and family’s psychosocial and developmental needs and goals. Though programs may differ in some ways, they are united in their aims to provide intentional, playful, and healing interventions for hospitalized children and families.

A dozen years of ovarian tissue cryopreservation at a pediatric hospital: tracking program and patient metrics while adapting to increasing needs

To review the program and patient metrics for ovarian tissue cryopreservation (OTC) within a comprehensive pediatric fertility preservation program in its first 12 years of development. Retrospective review. A tertiary children's hospital in a large urban center between March 2011 and February2023. Pediatric patients who underwent OTC. Unilateral oophorectomy for OTC. Patient demographics and clinical course information were collected for analysis. A total of 184 patients underwent OTC in the first 12 years. One hundred fifteen patients were prepubertal at the time of OTC, and 69 were postpubertal. In total, 128 patients (69.6%) received part of their planned therapy before OTC. Starting in 2018, 104 participants (92.0%) donated tissue to research, 99 participants (87.6%) donated blood, and 102 (90.2%) donated media to research. There was a decrease in the median age of patients who underwent OTC from 16.4-6.6 years and an overall increase in the proportion of patients per year that were prepubertal. Forty-eight (26.0%) patients who underwent OTC were outside referrals and traveled from as far as Seattle, Washington. During the first 12 years of this program, oncofertility research increased, annual tissue cryopreservation cases increased, and the median age of those who underwent OTC decreased. The program was adapted to build a stand-alone gonadal tissue processing suite and specialized in prepubertal ovarian tissue processing. The program will continue to adapt to patient needs in the upcoming decades because restoration technologies advance through research supported by this and collaborating programs.

Trends in cardiac CT utilization for patients with pediatric and congenital heart disease: A multicenter survey study

BackgroundThe use of cardiac CT (CCT) has increased dramatically in recent years among patients with pediatric and congenital heart disease (CHD), but little is known about trends and practice pattern variation in CCT utilization for this population among centers. MethodsA 21-item survey was created to assess CCT utilization in the pediatric/CHD population in calendar years 2011 and 2021. The survey was sent to all non-invasive cardiac imaging directors of pediatric cardiology centers in North America in September 2022. ResultsForty-one centers completed the survey. In 2021, 98% of centers performed CCT in pediatric and CHD patients (vs. 73% in 2011), and 61% of centers performed >100 CCTs annually (vs. 5% in 2011). While 62% of centers in 2021 utilized dual-source technology for high-pitch helical acquisition, 15% of centers reported primarily performing CCT on a 64-slice scanner. Anesthesia utilization, use of medications for heart rate control, and type of subspecialty training for physicians interpreting CCT varied widely among centers. 50% of centers reported barriers to CCT performance, with the most commonly cited concerns being radiation exposure, the need for anesthesia, and limited CT scan staffing or machine access. 37% (11/30) of centers with a pediatric cardiology fellowship program offer no clinical or didactic CCT training for categorical fellows. ConclusionWhile CCT usage in the CHD/pediatric population has risen significantly in the past decade, there is broad center variability in CCT acquisition techniques, staffing, workflow, and utilization. Potential areas for improvement include expanding CT scanner access and staffing, formal CCT education for pediatric cardiology fellows, and increasing utilization of existing technological advances.

In Memoriam: Professor Joseph Biederman’s Contributions to Child and Adolescent Psychiatry

Objective: To provide an overview of Joe Biederman’s contributions to child and adolescent psychiatry. Method: Nine colleagues described his contributions to: psychopharmacology, comorbidity and genetics, pediatric bipolar disorder, autism spectrum disorders, Tourette’s and tic disorders, clinical and neuro biomarkers for pediatric mood disorders, executive functioning, and adult ADHD. Results: Joe Biederman left us with many concrete indicators of his contributions to child and adolescent psychiatry. He set up the world’s first pediatric psychopharmacology clinic and clinical research program in child adolescent psychiatry. As a young faculty member he began a research program that led to many awards and eventual promotion to full professor at Harvard Medical School. He was for many years the most highly cited researcher in ADHD. He achieved this while maintaining a full clinical load and was widely respected for his clinical acumen. Conclusion: The world is a better place because Joe Biederman was here.

Addressing a Pre-Clinical Pipeline Gap: Development of the Pediatric Acute Myeloid Leukemia Patient-Derived Xenograft Program at Texas Children's Hospital at Baylor College of Medicine.

The survival rate of pediatric acute myeloid leukemia (pAML) is currently around 60%. While survival has slowly increased over the past few decades, the development of novel agents likely to further improve survival for this heterogeneous patient population has been limited by gaps in the pAML pre-clinical pipeline. One of the major hurdles in evaluating new agents for pAML is the lack of pAML patient-derived xenograft (PDX) models. Unlike solid tumors and other types of leukemias, AML is notoriously hard to establish in mouse models, likely due in part to the need for specific human microenvironment elements. Our laboratory at TCH/BCM addressed this gap by establishing a systematic PDX workflow, leveraging advanced immunodeficient hosts and capitalizing on our high volume of pAML patients and close coordination between labs and clinical sections. Patients treated at TCH are offered the chance to participate in specimen banking protocols that allow blood and bone marrow collection as well as the collection of relevant clinical data. All patients who consent and have samples available are trialed for PDX development. In addition, samples from the Children's Oncology Group (COG) are also trialed for PDX generation. Serially transplanting PDX models are validated using short tandem repeat (STR) and characterized using both targeted DNA/RNA next generation sequencing and RNAseq. As of March 2023, this systematic approach has resulted in 26 serially transplanting models. Models have been shared with requesting labs to facilitate external pAML pre-clinical studies. Available PDX models can be located through the BCM PDX Portal. We expect our growing PDX resource to make a significant contribution to expediting the testing of promising novel therapeutics for pAML.

Editorial comment to “Current state of inclusion and diversity in pediatric urology fellowship programs”

Editorial comment to “Current state of inclusion and diversity in pediatric urology fellowship programs”

Families Benefit After Utilization of a Clinic-Based Food Pantry Irrespective of Food Insecurity Experiences in a Pediatric Obesity Treatment Program.

To evaluate the congruence between food insecurity screening outcome and clinic-based food pantry utilization and to examine caregiver reported comfort, motivation, and benefits of utilization. Mixed-methods study. Academic pediatric obesity treatment clinic. Convenience sample of caregivers. Clinic-based food pantry offered irrespective of food insecurity screening outcome. Food insecurity screening (Hunger Vital Sign) and severity, self-rated caregiver health, willingness to disclose food insecurity and receive food, and food-related stress. Chi-square and t-tests were utilized to examine associations and descriptive analysis explored benefits. Rapid qualitative analysis was utilized to identify themes. Caregivers of 120 children were included (child mean age 11.8; 56.7% female, 67.6% Non-Hispanic Black), with 47 of 59 eligible completing follow-up surveys and 14 completing in-depth interviews. Approximately half (N = 30/59, 50.8%) of families utilizing the food pantry screened negative for food insecurity. Families utilizing the food pantry were more likely to report severe food insecurity (N = 23/59; 38.9%) compared to those declining (N = 3/61; 4.9%, P < .001). Caregivers accepting food were able to meet a child health goal (N = 30/47, 63.8%). Caregivers reported feeling comfortable receiving food (N = 13/14) and felt utilizing the food pantry led to consumption of healthier foods (N = 7/14). Families who screened both positive and negative for food insecurity utilized and benefited from a clinic-based food pantry. Clinics should consider strategies offering food resources to all families irrespective of screening outcome.

Treating Children and Adolescents with Obesity: Predictors of Early Dropout in Pediatric Weight-Management Programs.

Possible therapeutic failure of pediatric obesity is influenced by the high dropout rate. The aim of this study was to evaluate the rate of dropout and the rate of weight loss over the 24 months of follow-up. The retrospective, single-center study, involved 489 patients followed for obesity in the period 2016-2020. Patients' auxological data and blood samples were collected during the first (V1) and last visit (V2). Dropout was defined as a follow-up of less than 12 months and/or including less than one visit every 6 months. Patients were divided into two groups and compared: Group A of dropout (297 patients) and Group B of non-dropout (192 patients). In the follow-up period, which had a mean duration of 24 months, the dropout rate was 60.7%. In Group A, the percentage of patients with BMI ≥ 3 SD at V2 was significantly higher than that in Group B. In Group B, the percentage of patients with pathological HOMA-IR and with fasting glucose >100 mg/dL was higher than group A. The probability of dropout was positively associated with pubertal stage and negatively with impaired fasting glycemia and pathological insulinemia at V1. The study demonstrated a high dropout rate during follow-up, mainly among adolescents and patients with no glucometabolic alterations.

Strategies to Obtain and Deliver Blood Products Into Critically Injured Children: A Survey of Pediatric Trauma Society Members.

Timely transfusion is associated with improved survival and a reduction in in-hospital morbidity. The benefits of early hemorrhagic shock recognition may be limited by barriers to accessing blood products and their timely administration. We examined how pediatric trauma programs obtain blood products, the types of rapid infusion models used, and the metrics tracked to improve transfusion process efficiency in their emergency department (ED). We developed and distributed a self-report survey to members of the Pediatric Trauma Society. The survey consisted of 6 initial questions, including the respondent's role and institution, whether a blood storage refrigerator was present in their ED, the rapid infuser model used to transfuse critically injured children in their ED, if their program tracked 4 transfusion process metrics, and if a video recording system was present in the trauma bay. Based on these responses, additional questions were prompted with an option for a free-text response. We received 137 responses from 77 institutions. Most pediatric trauma programs have a blood storage refrigerator in the ED (n = 46, 59.7%) and use a Belmont rapid infuser to transfuse critically injured children (n = 45, 58.4%). The American College of Surgeons Level 1 designated trauma programs, or state-based equivalents, and "pediatric" trauma programs were more likely to have video recording systems for performance improvement review compared with lower designated trauma programs and "combined pediatric and adult" trauma programs, respectively. Strategies to improve the timely acquisition and infusion of blood products to critically injured children are underreported. This study examined the current practices that pediatric trauma programs use to transfuse critically injured children and may provide a resource for trauma programs to cite for transfusion-related quality improvement.

Evaluating the implementation of a community health worker-delivered intervention integrating asthma care in West Philadelphia public schools

Objective Schools are an important setting because students spend much of their time in school and engage in physical activity during the school day that could exacerbate asthma symptoms. Our objective is to understand the barriers and facilitators to implementing an experimental community health worker-delivered care coordination program for students with asthma within the context of the West Philadelphia Controls Asthma study. Methods Surveys (n = 256) and semi-structured interviews (n = 41) were completed with principals, teachers, nurses, and community health workers from 21 public and charter schools in West Philadelphia between January 2019 and September 2021. Survey participants completed the Evidence Based Practice Attitudes Scale, the Implementation Leadership Scale, and Organizational Climate Index. Semi-structured qualitative interview guides were developed, informed by the Consolidated Framework for Implementation Research. Results Participant responses indicate that they perceived benefits for schools and students related to the community health worker-based care coordination program. Several barriers and facilitators to implementing the program were noted, including challenges associated with incorporating the program into school nurse workflow, environmental triggers in the school environment, and challenges communicating with family members. An important facilitator that was identified was having supportive school administrators and staff who were engaged and saw the benefits of the program. Conclusions This work can inform implementation planning for other locales interested in implementing community-based pediatric asthma control programs delivered by community health workers in schools.

Impact of Brief Lactation Rotation in Residency on Decision to Refer for Lactation Support.

Breastfeeding challenges may be difficult to address within the constraints of a typical well-child visit. A team-based approach, including lactation consultants, can reduce physician workload, increase breastfeeding self-efficacy, and increase patient satisfaction. Continuity of care issues, including absent or delayed referrals, hinder patient access to skilled lactation support. To examine the post-residency referral patterns of physicians to lactation consultants among physicians who did or did not participate in a brief outpatient lactation rotation at an academic lactation clinic during residency. A cross-sectional online survey of physicians who completed residency programs in pediatrics, family medicine, or medicine-pediatrics between 2013 and 2022 was conducted using REDCap; 46 valid responses were received. Respondents who participated in a brief outpatient lactation rotation during residency refer patients to lactation consultants with significantly higher frequency than those who did not complete the rotation. Among those with lactation consultants in their geographic area, this relationship remained significant even when adjusting for residency type, gender, experience with an inpatient lactation consultant, and infant feeding attitudes using multiple linear regression. An outpatient lactation rotation during medical residency may increase the likelihood of referring to a lactation consultant in post-residency practice, which can improve breastfeeding outcomes.

A Comparison of State-Specific Pediatric Emergency Medical Facility Recognition Programs, 2020.

Prior research suggests that the presence of state-specific pediatric emergency medical facility recognition programs (PFRPs) is associated with high emergency department (ED) pediatric readiness. The PFRPs aim to improve the quality of pediatric emergency care, but individual state programs differ. We aimed to describe the variation in PFRP characteristics and verification requirements and to describe the availability of pediatric emergency care coordinators (PECCs) in states with PFRPs. In mid-2020, we collected information about each PFRP from 3 sources: the state Emergency Medical Services for Children (EMSC) website, the EMSC Innovation and Improvement Center website, or via communication with the state's EMSC program manager. For each state with a PFRP, we documented program characteristics, including program start date, number of tiers, whether participation was required/optional, and requirements for verification. Overall, we identified 17 states with active PFRPs. Five states had only 1 tier or level of recognition whereas the others had multiple. All programs did require presence of a PECC for verification. However, some PRFPs with multiple verification tiers did not require presence of a PECC to achieve each level of verification. In states with PFRPs, EDs with higher total visit volumes, a separate pediatric ED area, located in the Northeast, and earlier program start date were all more likely to have a PECC. There is variation in state PFRPs, although all prioritize the presence of a PECC. We encourage further research on the effect of different aspects of PFRPs on patient outcomes.

Narrative review in learning curve and pediatric robotic training program.

Studying learning curve (LC) for robotic procedures and developing an adequate training program are two fundamental steps to standardize robotic procedures. With this aim, we analyzed the literature to study the LCs of different robotic procedures and the availability of standardized training problems. The PubMed database was searched in the period from January 1995 to September 2022. Articles presenting LC and potential training programs in the pediatric population were chosen. Twenty papers were screened describing LC of robotic-assisted laparoscopic pyeloplasty (n=12), fundoplication (n=4), cholecystectomy (n=2), choledochal cyst resection (n=1), nephrectomy/partial nephrectomy (n=1) and lingual tonsillectomy (n=1), with a total of 1,251 procedures. In 10 studies there was only one single surgeon; nine had more than one; one did not specify how many surgeons participated. Twelve papers were retrospective single-center, three multicentric retrospective, four prospective and one was compared a retrospective case series to a prospective cohort. Most of these studies focused on operative time as the primary outcome. It was analyzed as the only outcome in three articles, along with complications in 14, time to discharge in eight, blood loss in three and pain killer use in three. The selected studies analyzed LC impacting operative planning (n=20), training (n=10) and costs (n=2). There is still a long way to go to complete a standardized functional training for robotic surgery procedures in pediatric surgery. Moreover, the progressive reduction in costs expected in the years to come will play a key role in progressing the diffusion of this technology enabling the collection of data necessary to create a standardized pediatric surgery robotic training program.

CLINICAL INTERNSHIP PROGRAM DEVELOPMENT IN AN ACADEMIC CARDIOPULMONARY EXERCISE LAB

https://youtu.be/L4guyGQnFdQ BACKGROUND Programs in exercise physiology, exercise science, kinesiology, sports sciences, and human performance encompassing both undergraduate and graduate studies are increasingly popular, providing education for a growing career field. Preparing students for healthcare careers requires adequate exposure and hands-on learning using experiential internship and practicum opportunities. An initiative to formalize the exercise science academic requirements for university programs is already in place and requires institutional program CAAHEP accreditation by 2027. Participation in a clinical internship and the hours required vary among college programs. This retrospective study performed on the cardiopulmonary internship program at a large Midwest pediatric hospital provides insight to clinical education and research skill development for undergraduate and graduate exercise science students. METHODS A retrospective review of program metrics and outcomes was analyzed regarding university affiliations with the internship program, number of students accepted into the internship program, completion rate, training and competencies, student academic level and associated culminating student presentations, and program satisfaction surveys for students completing their internship experience. RESULTS Between 2012 to 2023, the program grew from 3 to 40 university affiliation agreements/institutions. 143 students participated in the internship program: 32 fulfilled shadowing experiences, 90 were undergraduate interns and 21 were graduate interns. Internship hour requirements varied from 100 to 600 hours, with most students completing 350-450 hours. In 2012, the program enrolled 1 student per year, and by 2013 the capacity expanded to 4 student positions per semester (each spring, summer, fall). Internship students have presented 38 poster/abstract presentations at regional conferences and seminars. Students achieved 99% completion of site-specific sign-off competencies in cardiopulmonary exercise testing, including expanded requirements for cardiac rehabilitation starting in 2018. 98% of the student interns completed the program. CONCLUSIONS The cardiopulmonary internship program has continued to expand additional affiliate universities from both local and out of state institutions referring students to the pediatric internship program. Secondary to our cardiology program’s growth to include pediatric and now adult congenital patients, our outreach sites, and the expansion into cardiac rehabilitation and exercise prescription, the lab team members and allocated space have increased to accommodate increasing patient volumes. This has led to the ability to increase student interns per semester and expand their preparation for transition into the healthcare workforce. Understanding of the skills and competencies obtained during the practicum experience may help to enhance academic curriculum to transition students into clinical opportunities.

Longitudinal Pain Outcomes Following an Intensive Pediatric Pain Rehabilitation Program: Testing Potential Treatment Mechanisms.

This study tested performance measures of physical functioning and pain-related psychosocial measures as potential mechanisms of improvements in outcomes following intensive outpatient interdisciplinary pain rehabilitation for adolescents. We hypothesized that improvements in performance measures of physical functioning, fear of pain, pain catastrophizing, and self-efficacy during treatment would be related to improvements in pain, functional disability, and depressive symptoms. Seventy-seven adolescents, 10 to 18 years old, completed self-report measures before treatment, after the first week, at discharge, and at the 3-month follow-up. Participants completed physical performance measures of physical and exercise capacity and core strength on day 1, after the first week, and at discharge. Linear mixed models were used to examine the association between changes in potential mechanisms and changes in outcomes, adjusting for age, sex, pain duration, and baseline functional disability. Statistically significant improvement in functional disability, pain, and depressive symptoms was demonstrated across the 4 time points. Improvements were also demonstrated in physical performance measures, fear of pain, pain catastrophizing, and self-efficacy. Improvements in pain catastrophizing predicted improvements in functional disability, pain, and depressive symptoms. Improvements in self-efficacy predicted improvements in all outcome variables except depression. Improvements in physical performance measures predicted improvements in some aspects of functional disability and pain, but not depressive symptoms. This study contributes to the growing literature on the effectiveness of pediatric intensive interdisciplinary pain rehabilitation programs and mechanisms that influence improvements in outcomes, an area that is currently underexplored. Results are important to guide future research and inform clinical practice.

Abstract WP216: Results of a Pediatric Stroke Program Utilizing Stroke Telemedicine Across a Fifteen Hospital Healthcare System in Southern California

Background: The recognition of pediatric stroke symptoms is challenging. A regionwide pediatric stroke program utilizing an educational initiative across 15 emergency departments (ED) coupled with telemedicine was developed to standardize the process for immediate access to stroke experts and decrease door-to-intervention times. This study evaluates the impact of this intervention. Methods: Data from the pre- (1/2020-12/2021) vs post-intervention (1/2022-7/2023) including baseline demographics, volumes, and process measure timeframes: Door-to-Telestroke Page, Door-to-CT Interpretation, Door-to-Telestroke Call Back, and Door-to-Needle Time were abstracted. Chi-Square and Wilcoxon Rank Sum were used for statistical analysis. Results: There were a total of 92 Telestroke consults, with more in the post group: 35(38%) pre vs 57(62%) post (p=0.04). 52% were female with mean age of 12 (±1.2) years. 78(85%) were stroke mimics: 74% had non-cerebrovascular or migrainous neurological disorders as primary diagnoses. 7(7.6%) patients had interventions: 4(4.3%) thrombolytics, 9(9.7%) arterial or venous thrombectomies. 51% were discharged home and 43% were transferred to an acute care facility for higher level of care. There was no difference between pre- and post-implementation median [IQR] Door-to-Telestroke Page (17.5[14-21] vs 15[11-18] mins); Door-to-CT Interpretation (29[25-32] vs 27[23-29] mins) and Door-to-Needle Time. Median Post Door-to-Telestroke Call Back was faster (pre: 20[17-22] vs post: 16.0[13-18] mins [p=0.03]). Conclusion: Systemwide ED education coupled with telemedicine in implementing pediatric stroke systems of care in a large integrated healthcare system improves access to stroke specialists and time-based metrics in this low-volume, high-risk patient population.