US Pediatric Hospitals Research Articles

The Perfect Discharge: A Framework for High-Quality Hospital Discharges.

The Perfect Discharge: A Framework for High-Quality Hospital Discharges.

Discharge and Readmissions After Ventricular Assist Device Placement in the US Pediatric Hospitals: A Collaboration in ACTION.

Discharging children on ventricular assist device (VAD) support offers advantages for quality of life. We sought to describe discharge and readmission frequency in children on VAD support. All VAD-implanted patients aged 10-21 years at Advanced Cardiac Therapies Improving Outcomes Network (ACTION) centers were identified from the Pediatric Health Information System database (2009-2018). Discharge frequency on VAD was calculated. Patients discharged on VAD were compared with those not discharged. Freedom from readmission was assessed using the Kaplan-Meier method. A total of 298 VAD-implanted patients from 25 centers were identified, of which 163 (54.7%) were discharged. Discharges increased over time (36.9% [2009-2012] vs. 59.7% [2013-2018], p = 0.001). Of 144 discharged patients with follow-up, 96 (66.7%) were readmitted for reasons other than transplantation. Heart failure was the most common reason for readmission (27.7%), followed by infection (25.8%) and hematologic concerns (16.8%). In-hospital mortality on readmission was uncommon (1.8%) and the median length of stay was 6 days (interquartile range 2-19 days). Discharge of children on VAD support has increased over time, although variability exists across centers. Readmissions are common with diverse indications; however, the risk of mortality is low. Further interventions, including collaboration in ACTION, are critical to increasing discharges and optimizing outpatient management.

98. LOST IN TRANSLATION: SIMULTANEOUS SPANISH MEDICAL INTERPRETATION DURING FAMILY CENTERED ROUNDS FOR IMPROVED RESIDENT AND FAMILY ENGAGEMENT

Background Language barriers significantly contribute to medical errors compromising patient safety, quality of care, and resident engagement with patients. Spanish speakers account for the fastest growing population of patients within US pediatric hospitals. However, the communication needs of limited English proficiency (LEP) patients frequently remain unmet. PURPOSE: The purpose of this study is to implement equipment assisted simultaneous medical interpretation (EASMI) for Spanish speaking families on family centered bedside rounds (FCR) and determine family and trainee provider satisfaction. Methods In-person interpreters joined FCR at a tertiary care academic children's hospital. All medical discussion on FCR was interpreted simultaneously from English to Spanish. Interpreters wore a noise-cancelling microphone connected to a transmitter and family members were given a receiver with an earpiece. Qualitative interviews were performed with family members on their experience (N=25). Online qualitative and quantitative surveys were completed by medical students, residents, fellows, attendings, and nurses (N= 136). Results Surveys demonstrated 94% of physicians and 100% of nurses were “very satisfied” with EASMI. Common themes from the resident and fellow survey were improved efficiency of rounds, increased family engagement, improved understanding of the care plan, decreased communication errors and improving patient safety. After the intervention Spanish speaking families reported an increase in the domains of communication with physicians and nurses on the Child HCAHPS survey. Conclusion Medical interpretation for LEP patients and families is critical for improved healthcare and reduction in health disparities. Overall, EASMI is both an efficient and effective patient-centered intervention during pediatric FCR for increased trainee engagement with patients.

Medical Device-Related Pressure Injuries in Infants and Children.

The purpose of this study was to describe medical device-related pressure injuries (MDRPIs) in hospitalized pediatric patients. A prospective, descriptive study. The sample comprised 625 patients cared for in 8 US pediatric hospitals. Participants were aged preterm to 21 years, on bed rest for at least 24 hours, and had a medical device in place. Two nursing teams, blinded to the other's assessments, worked in tandem to assess pressure injury risk, type of medical devices in use, and preventive interventions for each medical device. They also identified the presence, location, and stage of MDRPI. Subjects were observed up to 8 times over 4 weeks, or until discharge, whichever occurred first. Of 625 enrolled patients, 42 (7%) developed 1 or more MDRPIs. Two-thirds of patients with MDRPIs were younger than 8 years. Patients experiencing MDRPIs had higher acuity scores on hospital admission, were more frequently cognitively and/or functionally impaired, or were extreme in body mass index. Respiratory devices caused the most injuries (6.19/1000 device-days), followed by immobilizers (2.40/1000 device-days), gastric tubes (2.24/1000 device-days), and external monitoring devices (1.77/1000 device-days). Of the 6336 devices in place, 36% did not have an MDRPI preventive intervention in place. Clinical variables contributing to MDRPI development included intensive care unit care (odds ratio [OR] 8.9, 95% confidence interval [CI] 1.9-43.6), use of neuromuscular blockade (OR 3.7, 95% CI 1.7-7.8), and inotropic/vasopressor medications (OR 2.7, 95% CI 1.7-4.3). Multivariable analysis indicated that Braden QD scores alone predicted MDRPI development. Medical devices are common in hospitalized infants and children and these medical devices place patients at risk for MDRPI.

A Contemporary Snapshot of Circumcision in US Children’s Hospitals

Background: In 2012, the American Academy of Pediatrics (AAP) concluded the health benefits of circumcision during the neonatal period outweigh the risks, a shift from its 1999 statement. The national trends for circumcisions since 2012 are unclear. Herein, we describe trends in male circumcision in US pediatric hospitals. Methods: Using the …

Respiratory Syncytial Virus-Associated Hospitalizations Among Young Children: 2015-2016.

Respiratory syncytial virus (RSV) is a major cause of hospitalized acute respiratory illness (ARI) among young children. With RSV vaccines and immunoprophylaxis agents in clinical development, we sought to update estimates of US pediatric RSV hospitalization burden. Children <5 years old hospitalized for ARI were enrolled through active, prospective, population-based surveillance from November 1, 2015, to June 30, 2016, at 7 US pediatric hospital sites. Clinical information was obtained from parent interviews and medical records. Midturbinate nasal and throat flocked swabs were collected and tested for RSV by using molecular diagnostic assays at each site. We conducted descriptive analyses and calculated population-based rates of RSV-associated hospitalizations. Among 2969 hospitalized children included in analyses, 1043 (35%) tested RSV-positive; 903 (87%) children who were RSV-positive were <2 years old, and 526 (50%) were <6 months old. RSV-associated hospitalization rates were 2.9 per 1000 children <5 years old and 14.7 per 1000 children <6 months old; the highest age-specific rate was observed in 1-month-old infants (25.1 per 1000). Most children who were infected with RSV (67%) had no underlying comorbid conditions and no history of preterm birth. During the 2015-2016 season, RSV infection was associated with one-third of ARI hospitalizations in our study population of young children. Hospitalization rates were highest in infants <6 months. Most children who were RSV-positive had no history of prematurity or underlying medical conditions, suggesting that all young children could benefit from targeted interventions against RSV.

Measuring the Burden of RSV in Children to Precisely Assess the Impact of Preventive Strategies.

* Abbreviations: CI — : confidence interval RSV — : respiratory syncytial virus WGA — : weeks’ gestational age Respiratory syncytial virus (RSV) is a major cause of childhood morbidity across the world and mortality in low- to middle-income countries.1 In the United States, RSV represents the most frequent cause of hospitalization in the first year of life.2 As efforts are gaining momentum to develop new strategies (vaccines and monoclonal antibodies) to prevent RSV infections,3 it becomes even more important to have precise data on the disease burden. In this issue of Pediatrics, Rha et al4 report an active, prospective, multicenter, population-based surveillance study of the burden of RSV hospitalizations among US children <5 years of age from November 2015 to June 2016. The study has significant strengths because it includes 7 US pediatric hospitals of diverse geography; the authors use a broad definition of acute respiratory infections and proven RSV infection based on validated, polymerase chain reaction–based diagnostic assays. Among 4716 eligible children, the investigators enrolled 3001 (64%) and obtained adequate samples in 2983 (99%). Of those, 2969 children had conclusive results, and 1043 (35%) were positive for RSV. The rate of RSV-associated hospitalizations was 2.9% per 1000 in children <5 years old and 6.3% per 1000 in those <24 months old. With these … Address correspondence to Octavio Ramilo, MD, Nationwide Children’s Hospital, Room WA4021, 700 Children’s Drive, Columbus, OH 43205. E-mail: octavio.ramilo{at}nationwidechildrens.org

Epidemiology and trend of US pediatric burn hospitalizations, 2003–2016

BackgroundThermal injury is a leading cause of unintentional pediatric trauma morbidity and mortality. MethodsThis retrospective analysis of the 2003–2016 Kids’ Inpatient Database (KID) included children <18 years old with a burn principal diagnosis. The objectives were to describe the trend of US pediatric burn hospital admissions and the patient and hospital characteristics of admitted children in 2016. The trends (2003–2012) and (2012–2016) were evaluated separately due to the 2015 implementation of International Classification of Diseases, Tenth Revision (ICD-10). ResultsThe population rate of pediatric burn admissions decreased by 4.6% from 2003 to 2012, but the proportion of admissions to hospitals with burn pediatric patient volumes≥100 increased by 63.9%. The overall mortality rate of hospitalized burn patients decreased by 48.1%. Median length of stay increased slightly for patients with a burn ≥20% total body surface area (TBSA) but decreased for patients with TBSA burn <20%. From 2012 to 2016, the population rate decreased by 13.4%. In 2016, an estimated 8160 children were admitted with a burn principal diagnosis, and 41.4% transferred in from other facilities. Children age 1–4 years were the most commonly admitted age group (49.7%). Patients with ≥20% TBSA burns accounted for 7.8% of admissions (95% confidence interval [CI]: 5.1–10.4%). Burn-related complications were documented in 5.9% of admissions (95% CI: 4.6–7.1%). ConclusionPediatric burn hospitalizations and burn-related mortality have decreased over time. The increases in transfers and admissions to hospitals with high pediatric burn volumes suggest increasing regionalization of care.

Discharge and Readmissions after VAD Placement in US Pediatric Hospitals: A Collaboration in ACTION

There is a concerted effort to increase discharges of children on ventricular assist device (VAD) support. Optimizing this process represents a quality improvement target of Advanced Cardiac Therapies Improving Outcomes Network (ACTION). We sought to describe discharge and readmission frequency in children on VAD support using a multicenter administrative database. All VAD-implanted patients aged 10-21 years at ACTION centers were identified from the Pediatric Health Information System database (2009-2018). Discharge frequency on VAD was calculated. Patients discharged on VAD were compared to those not discharged. Freedom from readmission was assessed using the Kaplan Meier method, censoring at readmission for transplantation. The indications for readmission were determined using ICD diagnosis codes. A total of 298 patients from 25 centers were identified, of which 163 (54.7%) were discharged. The discharge frequency ranged from 8% to 100% across centers. The frequency of discharge increased over time (36.9% [2009-2012] vs. 59.7% [2013-2018], p=0.001). Of 144 discharged patients with follow-up data, 96 (66.7%) were readmitted for reasons other than transplantation with a median time to readmission of 45 days (IQR 18-79) [Figure]. Heart failure was the most common reason for readmission (27.7%), followed by infection (25.8%), hematologic concerns (16.8%), neurologic events (8.6%), arrhythmias (7.8%), and fluid/electrolyte problems (4.7%). In-hospital mortality on readmission was uncommon (1.8%) and the median length of stay was 6 days (IQR 2-19 days). Patients discharged with VADs from ACTION centers has increased over time, with high variability across centers. Readmissions are common with diverse indications; however, the risk of mortality during a readmission encounter is low. Further collaboration in ACTION is critical to optimize the outpatient management of this vulnerable population.

1493. Creation and External Validation of a Clinical Prediction Rule for Diarrheal Etiology Using Natural Language Processing

BackgroundInfectious diarrheal illness is a significant contributor to healthcare costs in the US pediatric population. New multi-pathogen PCR-based panels have shown increased sensitivity over previous methods; however, they are costly and clinical utility may be limited in many cases. Clinical Prediction Rules (CPRs) may help optimize the appropriate use of these tests. Furthermore, Natural Language Processing (NLP) is an emerging tool to extract clinical history for decision support. Here, we examine NLP for the validation of a CPR for pediatric diarrhea.MethodsUsing data from a prospective clinical trial at 5 US pediatric hospitals, 961 diarrheal cases were assessed for etiology and relevant clinical variables. Of 65 variables collected in that study, 42 were excluded in our models based on a scarcity of documentation in reviewed clinical charts. The remaining 23 variables were ranked by random forest (RF) variable importance and utilized in both an RF and stepwise logistic regression (LR) model for viral-only etiology. We investigated whether NLP could accurately extract data from clinical notes comparable to study questionnaires. We used the eHOST abstraction software to abstract 6 clinical variables from patient charts that were useful in our CPR. These data will be used to train an NLP algorithm to extract the same variables from additional charts, and be combined with data from 2 other variables coded in the EMR to externally validate our model.ResultsBoth RF and LR models achieved cross-validated area under the receiver operating characteristic curves of 0.74 using the top 5 variables (season, age, bloody diarrhea, vomiting/nausea, and fever), which did not improve significantly with the addition of more variables. Of 270 charts abstracted for NLP training, there were 41 occurrences of bloody diarrhea annotated, 339 occurrences of vomiting, and 145 occurrences of fever. Inter-annotator agreement over 9 training sets ranged between 0.63 and 0.83.ConclusionWe have constructed a parsimonious CPR involving only 5 inputs for the prediction of a viral-only etiology for pediatric diarrheal illness using prospectively collected data. With the training of an NLP algorithm for automated chart abstraction we will validate the CPR. NLP could allow a CPR to run without manual data entry to improve care. Disclosures All authors: No reported disclosures.

1595. Comparative In Vitro Activity of Imipenem–Relebactam Against Drug-Resistant Gram-Negative Isolates from Pediatric Patients

BackgroundDrug resistance in Gram-negative bacteria is of particular concern in children. Relebactam, a novel diazabicyclooctane inhibitor, coupled with imipenem has broad-spectrum activity against β-lactamase producing organisms. Here, we compare the in vitro activity of imipenem-relebactam to 10 standard comparator drugs against resistant Gram-negative isolates from two US pediatric hospitals.MethodsWe tested 100 isolates (50 per site) from pediatric clinical specimens tested during 2015–2017. All isolates were extended-spectrum cephalosporin-resistant (ESC-R); more than half were multidrug resistant (67%). Selected ESC-R isolates included Escherichia coli (90), Klebsiella pneumoniae (8), Klebsiella oxytoca (1), and Enterobacter cloacae (1) that were resistant or intermediate to ≥1 cephalosporins and/or aztreonam. A 0.5 McFarland suspension was prepared from colonies grown on blood agar plates (Thermo Scientific) at 35 ± 1°C for 18–24 hours. A final inoculum of 5 × 105 CFU/mL was prepared in Mueller–Hinton broth. Sensititre plates (Thermo Fisher Scientific) containing graded concentrations of imipenem/relebactam and 10 comparator drugs were inoculated and incubated at 35 ± 1°C for 18–24 hours. The minimum inhibitory concentration (MIC) was determined using the Sensititre Vizion system (Thermo Fisher Scientific) and endpoints were interpreted using CLSI (2019) breakpoint criteria, with the exception of colistin (EUCAST 2019).ResultsSelected ESC-R isolates had high rates of resistance to cephalosporins (64%–97%), aztreonam (80%), and levofloxacin (61%). All isolates were susceptible to imipenem/relebactam, imipenem and meropenem (MIC, ≤1 μg/mL for all). The imipenem/relebactam MIC50 (0.06 μg/mL) and MIC90 (0.12 μg/mL) values for ESC-R isolates were within one dilution of MICs of imipenem alone (0.12 μg/mL and 0.25 μg/mL). Among the comparators, colistin, amikacin, and piperacillin/tazobactam demonstrated comparable activities with 100%, 99%, and 94% susceptibilities, respectively.ConclusionMeropenem, imipenem alone and in combination with relebactam exhibited 100% susceptibilities against ESC-R Enterobacteriaceae isolated from pediatric specimens, demonstrating the high potency of carbapenems. Disclosures All authors: No reported disclosures.

Pneumocystis Infection in Children: National Trends and Characteristics in the United States, 1997-2012.

Although the epidemiology of immunocompromising condition in children has evolved over time, updated epidemiology of pediatric pneumocystis infection in the United States is not available. We performed a retrospective analysis using the Kids' Inpatient Database, a nationally representative sample of US pediatric hospital discharges collected in 1997, 2000, 2003, 2006, 2009 and 2012. Pneumocystis cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification, code 136.3 among children 0-18 years of age. Demographic data of cases with and without mortality were compared. We identified 1902 [standard error (SE): 95] pneumocystis cases during the study period. The pneumocystis hospitalization rate decreased from 7.5 (SE: 0.91) to 2.7 (SE: 0.31) per a million US children from 1997 to 2012 (63.2% decrease). Cases with HIV infection decreased from 285 (SE: 56) cases in 1997 to 29 (SE: 7) cases in 2012, whereas hematologic malignancy and primary immunodeficiency became more prominent. Infants were the most commonly affected [510 cases (SE: 40)]. All-cause in-hospital mortality was 11.7% (SE: 1.3%) and was particularly high among cases with hematopoietic stem cell transplant [32.4%(SE: 7.1%); P < 0.001]. Pneumocystis infection in children showed a marked decrease from 1997 to 2012 in the United States, largely driven by the reduction in HIV-associated cases, and cases with non-HIV illnesses became more prominent. Hematopoietic stem cell transplant-associated cases had particularly high mortality. Clinicians should be aware of high-risk groups that may benefit from chemoprophylaxis, particularly in infancy.

Off-label Medication Prescribing Patterns in Pediatrics: An Update.

To describe the frequency of off-label drug use in 2014 as defined by the Food and Drug Administration (FDA)-approved age ranges in patients ≤18 years of age, to determine the rate of off-label drug use in 2014 by drug classification, and to compare current off-label medication usage rates with historical rates. This is a retrospective cohort study of an administrative database containing inpatient resource use data from January 1, 2014, to December 31, 2014. Patients ≤18 years of age receiving 1 of 76 selected commonly prescribed medications are included. Off-label drug use is defined as use in a patient younger than the lower limit of the FDA-approved age range for any indication or dosage form of that drug. At least 1 drug was prescribed off label in 779 270 of 2 773 770 (28.1%) patient visits during the study period. Younger age, longer hospital stays, and mortality were associated with higher rates of off-label medication prescription. Off-label usage of certain medications differed between care settings. Rates of off-label medication use were higher in observational (45.5%), inpatient (53.9%), and ambulatory (54.2%) settings. Although off-label drug use at major US pediatric hospitals is declining, 1 out of every 4 medications is not in accordance with FDA label indications for patient age. There exists substantial variation in off-label drug use among drug categories and encounter types. Although many commonly prescribed medications are FDA-approved for use in subpopulations of pediatric patients, studies of their safety, efficacy, pharmacokinetics, and optimal dosing are ongoing.

Secular trends in emergency department encounters for concussion at US children's hospitals by age group (2008–2017)

BackgroundIncreased concussion rates in US youth have been documented since 2000. Concomitant rises in healthcare utilization for concussion are likely attributable to public health, media, and legislative initiatives aimed at increasing public awareness of the importance of seeking medical attention after injury. Utilization trends in young children have not been well-documented, however.ObjectiveTo characterize recent secular trends in pediatric emergency department (ED) encounters for concussion by 4-year age group.MethodsUsing Children's Hospital Association's Pediatric Health Information System data, we examined a retrospective cohort of patients aged 2–17 years with an ED encounter for concussion at 22 US pediatric hospitals with continuous data between 2008 and 2017. Average annual change in rates of ED visits for concussion and sports-/recreation-related concussion, imaging, and admissions were estimated via weighted least-squares regression.ResultsED encounters with a primary indication of concussion comprised 0.8% (n = 86,393) of all ED encounters in 2008–2017. Over time, ED concussion visits in 6–17-year-olds increased by 0.5–1.1 per 1,000 ED encounters per year (all Ptrend&lt; 0.0001), while rates among 2-5-year-olds remained stable (Ptrend = 0.72). Rates for sports-/recreation-related concussions increased significantly across all age groups (&lt;0.0001 ≤ Ptrend ≤ 0.01). Absolute number undergoing any imaging increased in all age groups; however, due to increased ED concussion encounters, the rate of imaging decreased overall (−29.7/1,000 ED concussion encounters/year; Ptrend &lt; 0.0001) and across all age groups; the imaging rate decreased less for 2-5-year-olds (−19.6/1,000 encounters/year; Ptrend &lt; 0.0001). Likewise, admission rates declined significantly over time overall (−10.1/1,000 encounters/y; Ptrend = 0.0006) and for all age groups.ConclusionsED concussion encounter rates in US youth aged 6–17 years continue to increase at pediatric hospitals, suggesting awareness efforts have been effective. Conversely, imaging and admission rates have decreased, indicating efforts to curtail unnecessary irradiation and intervention have also been successful. Trends in 2-5-year-olds were somewhat different from older youth and should be explored further.

1132. Pneumocystis Infection in Children: National Trends and Characteristics in the United States, 1997–2012

BackgroundAlthough epidemiology of immunocompromising condition in children has evolved over time, updated epidemiology of pediatric pneumocystis infection in the United States is not available.MethodsWe performed a retrospective analysis using the Kids’ Inpatient Database, a nationally representative sample of US pediatric hospital discharges collected in 1997, 2000, 2003, 2006, 2009, and 2012. Pneumocystis cases were identified using International Classification of Diseases, Ninth Revision, Clinical Modification code 136.3 among children aged 0–18 years. Demographic data of cases with and without mortality were compared.ResultsWe identified 1,902 (standard error, SE: 95) pneumocystis cases during the study period. The pneumocystis hospitalization rate decreased from 7.5 (SE: 0.91) to 2.7 (SE: 0.31) per a million US children from 1997 to 2012 (63.2% decrease). Cases with human immunodeficiency virus (HIV) infection decreased from 285 (SE: 56) cases in 1997 to 29 (SE: 7) cases in 2012, although non-HIV-associated cases remained relatively stable. After 2009, HIV was the third common underlying disorder after hematologic malignancy and primary immunodeficiency. All-cause in-hospital mortality was 11.7% (SE: 1.3%) and was particularly high among cases with hematopoietic stem cell transplant (HSCT) (32.4% [SE: 7.1%]) (P < 0.001).ConclusionPneumocystis infection in children showed a marked decrease from 1997 to 2012 in the United States, largely driven by the reduction in HIV-associated cases. Non-HIV illnesses including hematologic malignancy and primary immunodeficiency became prominent underlying conditions over time. HSCT-associated cases had particularly high mortality. Non-HIV conditions should be the target for primary and secondary prevention in reducing the disease burden. Disclosures All authors: No reported disclosures.

Central precocious puberty in Boston boys: A 10-year single center experience.

ObjectiveRecent studies in the US and abroad suggest that boys are undergoing puberty at a younger age. It is unknown if this secular trend extends to boys with central precocious puberty (CPP), who sit at the extreme end of the pubertal spectrum, and if neuroimaging should remain a standard diagnostic tool.Study designRetrospective chart review of all boys with CPP seen by Endocrinology at a US pediatric hospital from 2001–2010.ResultsFifty boys had pubertal onset at an average age of 7.31 years (95CI 6.83–7.89), though many did not present until nearly one year thereafter, by which time 30% were mid-to-late pubertal. Boys were predominantly non-Hispanic White and 64% were overweight/obese. The majority (64%) of boys had neurogenic CPP (CNS-CPP) with neurofibromatosis type I being the most common diagnosis. Diagnosis of CPP led to discovery of a neurogenic lesion in only 3 of 32 (9%) CNS-CPP cases. The remaining boys, with idiopathic CPP (36%), were indistinguishable from those with CNS-CPP aside from four boys who endorsed a family history of PP (22% vs. 0% among CNS-CPP cases). Importantly, there was no change in the incidence of male CPP after accounting for the increase in clinic volume during this time period.ConclusionIn this contemporary Boston-based cohort of 50 boys with CPP, most cases were neurogenic, consistent with older literature. Several idiopathic cases had a family history of PP but were otherwise indistinguishable from CNS-CPP cases. Thus, neuroimaging remains a critical diagnostic tool. We find no evidence for an increase in the prevalence of male CPP.

Risk Factors, Geographic Distribution, and Healthcare Burden of Symptomatic Congenital Cytomegalovirus Infection in the United States: Analysis of a Nationally Representative Database, 2000-2012

To assess risk factors, geographic distribution, length of stay, and total charges per case of symptomatic congenital cytomegalovirus infection (cCMV). We performed retrospective analyses of serial cross-sectional data using the Kids' Inpatient Database, a nationally representative sample of US pediatric hospital discharges, from 2000, 2003, 2006, 2009, and 2012. Symptomatic cCMV was identified via use of the International Classification of Diseases, Ninth Revision, Clinical Modification code 771.1 among records with in-hospital birth that were accompanied by 1 or more characteristic symptoms. Demographic characteristics were compared with multivariable logistic regression. Temporal trend was assessed using linear regression. Charges were adjusted for inflation to 2012 US dollars. We identified 1349 cases of symptomatic cCMV (SE 56). Symptomatic cCMV was associated with non-Hispanic black race (OR 1.70; 95% CI 1.37-2.10), government-sponsored insurance (OR 1.95; 95% CI 1.34-2.83), and birth in the American South and West (OR 1.68, 95% CI 1.35-2.09 and OR 1.61, 95% CI 1.23-2.09, respectively). In-hospital mortality and preterm birth rate ranged from 3.2%-6.8% and 50.4%-59.2%, respectively, without temporal changes. The geometric mean of total charges per case doubled from $45 771 (SE $8509) in 2000 to $89 846 (SE $10 358) in 2006 (P = .002) but did not change from 2006 to 2012. Length of stay in days was 15 (IQR 8-22) in 2000, 27 (IQR, 9-51) in 2009, and 18 (IQR, 8-47) in 2012. Symptomatic cCMV was associated with non-Hispanic black race, low socioeconomic status, and birth in the American South and West and resulted in substantial healthcare burden.

Medical Emergency Team Event Characteristics from an Australian Pediatric Hospital: A Single-Center, Retrospective Study

To describe the characteristics of medical emergency team (MET) events at an Australian pediatric, tertiary-care center in a way that would allow for comparison with other MET systems. A retrospective, single-center, observational study. Consecutive MET events that occurred between January 2013 and July 2014 at Princess Margaret Hospital for Children in Perth, Western Australia, were included. There were 46 445 hospital admissions during the study period and 197 MET events in children. This gives a rate of 4.2 MET events per 1000 admissions. Out of 197 pediatric MET events analyzed, there were 2 deaths (1.0%) that occurred during the MET events. All 197 patients were actively treated, with none receiving "do not attempt resuscitation" orders. Of pediatric MET events, 24% (48 of 197) were admitted to the PICU, and 75% (149 of 197) stayed in the ward where the call was made. In this tertiary-care, pediatric hospital in Australia, the MET event rate and the rate of admission to the PICU because of MET events are lower than those reported for US pediatric hospitals. Despite these differences, Australian data suggest that outcomes are similar to US pediatric hospitals.

Enterovirus D68, a highly pathogenic and epidemic virus

Since its discovery in 1962, enterovirus D68 (EV-D68) was one of the less frequently detected enteroviruses by the surveillance networks worldwide. In 2014, US pediatric hospitals reported increases in the number of children with severe respiratory illness. Following the alerts from the Center for Disease Control and Prevention, numerous cases of EV-D68were reported in many countries. EV-D68is associated with severe respiratory infections in children and adults, mostly in patients with underlying respiratory diseases. Like with poliovirus and EV-A71, rare but severe neurological complications may occur: acute flaccid myelitis is characterized by rapid onset of weakness and distinct abnormalities of the spinal cord gray matter on magnetic resonance imaging. Molecular epidemiology of strains isolated worldwide since the 90s shows a rapid evolution of the virus, reflecting its wide circulation in the general population. The recent emergence of EV-D68underlines the unpredictable epidemic properties and the neurotropism of enteroviruses.

Psychiatric Boarding in the Pediatric Inpatient Medical Setting: A Retrospective Analysis.

Psychiatric concerns are a common presenting problem for pediatric providers across many settings, particularly on inpatient medical services. The volume of youth requiring intensive psychiatric treatment outnumbers the availability of psychiatric placements, and as a result many youth must board on pediatric medical units while awaiting placement. As the phenomenon of boarding in the inpatient pediatric setting increases, it is important to understand trends in boarding volume and characteristics of pediatric psychiatric boarders (PBs) and understand the supports they receive while boarding. A retrospective chart review of patients admitted as PBs to a medical inpatient unit at a large northeastern US pediatric hospital during 2013. Four hundred thirty-seven PBs were admitted to the medical service from January to December 2013, representing a more than 50% increase from PB admissions in 2011 and 2012. Most PBs were admitted for suicidal attempt and/or ideation. Average length of boarding was 3.11 ± 3.34 days. PBs received a wide range of mental health supports throughout their admissions. PBs demonstrated modest but statistically significant clinical improvements over the course of their stay, with only a small proportion demonstrating clinical deterioration. Psychiatric boarding presents many challenges for families, providers, and the health care system, and PBs have complex psychiatric histories and needs. However, boarding may offer a valuable opportunity for psychiatric intervention and stabilization among psychiatrically vulnerable youth.