A Retrospective Observational Study of Vibrating Mesh Nebulizers in the Pediatric Emergency Department.

Objective: To determine outcomes of bronchodilator delivery with a vibrating mesh nebulizer (VMN) in a pediatric emergency department (ED).

Methods: We performed an in vitro analysis of the VMN and a retrospective observational study of patients receiving nebulized albuterol for a respiratory indication before (April 24, 2022-August 11, 2022) and after (April 24, 2023-July 29, 2023) introduction of the VMN in the ED.

Results: Six hundred five children ages 1 to 17 years were included (302 preintervention, 303 postintervention).

Standardization of Clinician Outcomes for Croup Using a Clinical Pathway.

Objective: Croup management varies significantly between hospitals and clinicians. We assessed the level of clinician variation with a clinical croup pathway in the pediatric emergency department (PED) and the impact of a pathway change on admission rates.

Methods: This was a retrospective cohort study of children with croup in a PED at an academic referral hospital between 2018 and 2022.

Patient Caregiver Perspectives on Accessing Language Interpretation in a Pediatric Emergency Department.

Patients and caregivers with a language for care other than English (LOE) are at risk for inequitable care in the pediatric emergency department (ED). Professional interpretation (PI) improves outcomes, but there can be complexity in determining optimal language for care and interpretation need. Our goal was to learn more about the perspectives from caregivers who speak different languages regarding interpretation with a survey near ED discharge.

Impact of Strict Isolation Precautions on Families with a Language Other than English.

Introduction: Children with a language for care other than English (LOE) are at risk for inequitable care. We examined the association of isolation precautions in the care of hospitalized children with LOE through the frequency of professional interpreter use and timing of in-person consultation.

Methods: Retrospective cohort study of children in a strict isolation unit (SIU) between 2/2020 and 12/2021.

Historical redlining and survival among children, adolescents, and young adults with cancer diagnosed between 2000-2019 in Seattle and Tacoma, Washington.

Background: Historical redlining has been associated with inferior survival in adult-onset cancers. However, its relationship with pediatric, adolescent, and young-adult-onset cancer outcomes is unknown.

Methods: This study identified incident cancer among individuals <40 years of age living in Seattle and Tacoma between 2000-2019 via the population-based Cancer Surveillance System.

Association Between Language, Interpreter Use, and Pediatric Surgical Outcomes.

Background: Inequities exist in pediatric surgical outcomes. Differential outcomes have been identified across racial groups, geography, and socioeconomic standing. However, the association between preferred language, interpreter use, and surgical outcomes is not well-studied in pediatric surgical literature.

Functional MRI for bilingual epilepsy surgery patients: serving a diverse pediatric cohort.

Objective: Functional MRI (fMRI) helps with the identification of eloquent cortex to assist with function preservation in patients who undergo epilepsy surgery. Language and memory tasks can even be used effectively in clinically involved pediatric patients. Most pediatric studies report on English speaking-only cohorts from English-dominant countries, yet languages other than English (LOEs) are increasingly prevalent in countries such as the US.

Comparative Analysis of Indices for Social Determinants of Health in Pediatric Surgical Populations.

Importance: Conclusions vary substantially among studies examining associations between area-based social determinants of health (SDOH) and pediatric health disparities based on the selected patient population and SDOH index. Most national studies use zip codes, which encompass a wide distribution of communities, limiting the generalizability of findings.

Objectives: To characterize the distributions of composite SDOH indices for pediatric surgical patients within a national sample of academic children's hospitals and to assess SDOH index precision in classifying patients at similar levels of disadvantage.

Equity-Focused Interventions Improve Interpreter Use in the Pediatric Intensive Care Unit.

Background: Federal guidelines and equitable care mandate that patients who use a language other than English receive interpretation in their preferred language. Substantial variability exists in interpreter use in intensive care settings. We aimed to increase the rate of interpretations in our pediatric intensive care unit (PICU) through a series of targeted interventions.

Utility of acid citrate dextrose-acidification for platelet volume reduction protocols in the transfusion service.

Background: Volume-reduced platelets can minimize circulatory overload, allergic transfusion reactions, or out-of-group plasma infusion. Our center adopted a volume reduction protocol that includes acidification with acid citrate dextrose solution A (ACD-A) before centrifugation and without any rest period prior to resuspension allowing a better turnaround time for platelet issue.

Study Design And Methods: This report compares corrected count increments (CCIs) from full-volume and ACD-A acidified volume-reduced human platelets in a retrospective study at a single hospital and in a mouse model.

A Study of Skeletal Survey Disparity in Pediatric Head Injury in the Emergency Department.

The objective of this study was to evaluate disparities in skeletal survey (SS) use for pediatric. head injury patients in the emergency department (ED). This was a multi-site retrospective.

Anticoagulation for Septic Cerebral Venous Thrombosis in Childhood.

Anticoagulation is recommended for most children with cerebral venous thrombosis (CVT) to prevent venous infarction and promote recanalization. An exception is CVT associated with head and neck infection (septic CVT), for which treatment of infection without concomitant use of anticoagulation is recommended. Despite this, the use of anticoagulation in septic CVT is controversial, and children with septic CVT are often anticoagulated due to concerns about thrombus progression and persistence despite infection treatment.

Triage Discordance in an Academic Pediatric Emergency Department and Disparities by Race, Ethnicity, and Language for Care.

Background: Minoritized patients are disproportionately represented in low-acuity emergency department (ED) visits in the United States in part caused by lack of timely access to primary and urgent care. However, there is also the possibility that implicit bias during triage could contribute to disproportionate representation of minority groups in low-acuity ED visits. Triage discordance, defined as when ED resources used are different from initial triage score predictions, can be used as a proxy for triage accuracy.

Changes in Inhaled Nitric Oxide Use Across ICUs After Implementation of a Standard Pathway.

Objectives: Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator. It is expensive, frequently used, and not without risk. There is limited evidence supporting a standard approach to initiation and weaning.

Reducing Time to Electroencephalography in Pediatric Convulsive Status Epilepticus: A Quality Improvement Initiative.

Background: Pediatric convulsive status epilepticus (CSE) is a neurological emergency utilizing electroencephalography (EEG) to guide therapeutic interventions. Guidelines recommend EEG initiation within one hour of seizure onset, but logistic and structural barriers often lead to significant delays. We aimed to reduce the time to EEG in pediatric CSE.

Clinical outcomes of pediatric hemispherectomy following unsuccessful subhemispheric resection for refractory epilepsy: a case review study.

Objective: Epilepsy surgery remains one of the most underutilized procedures in epilepsy despite its proven superiority to other available therapies. This underutilization is greater in patients in whom initial surgery fails. This case series examined the clinical characteristics, reasons for initial surgery failure, and outcomes in a cohort of patients who underwent hemispherectomy following unsuccessful smaller resections for intractable epilepsy (subhemispheric group [SHG]) and compared them to those of a cohort of patients who underwent hemispherectomy as the first surgery (hemispheric group [HG]).

Thrombophilia screening in the routine clinical care of children with arterial ischemic stroke.

Background: Current guidelines recommend thrombophilia evaluation in childhood arterial ischemic stroke, but the impact of screening on management is unknown. The objective of the current study is to report the incidence of thrombophilia identified as part of routine clinical care in the context of available literature reports, and to describe the impact of a diagnosis of thrombophilia on patient management.

Methods: We conducted a single-institution retrospective chart review for all children with arterial ischemic stroke occurring between January 1, 2009 and January 1, 2021.

Sumatriptan as a First-Line Treatment for Headache in the Pediatric Emergency Department.

Background: Headache is a common presenting condition for patients seen in the pediatric emergency department (ED). Intranasal (IN) sumatriptan is a well-tolerated and safe abortive treatment for migraine headache, but it is infrequently administered in pediatric EDs. In this study we characterize an ED migraine pathway that uses IN sumatriptan as a first-line treatment.

Geographic access to care and pediatric surgical outcomes.

Introduction: Rurality and distance traveled for healthcare are associated with worse pediatric health indicators.

Methods: We retrospectively analyzed patients ages 0-21 at a quaternary pediatric surgical facility with a large rural catchment area between 1/1/2016-12/31/2020. Patient addresses were designated as metropolitan or non-metropolitan.

Socioeconomic disadvantage and pediatric surgical outcomes.

Introduction: The impact of socioeconomic status on surgical outcomes has not been well-studied in children. Area Deprivation Index (ADI) is a validated measure of neighborhood-level socioeconomic disadvantage.

Methods: A retrospective analysis of surgical patients ages 0-21 years was performed at a quaternary pediatric hospital from 1/1/2016-12/31/2020.

Prognostic Value of Preoperative and Postoperative Electroencephalography Findings in Pediatric Patients Undergoing Hemispheric Epilepsy Surgery.

Objective: The seizure outcomes after hemispheric epilepsy surgery have been excellent, with 54%-90% of patients achieving long-term freedom from seizures. Similarly, the neuropsychological outcomes have been favorable. The prognostic value of pre- and postoperative electroencephalography (EEG) has not been well-studied.

Precision medicine in pediatric temporal epilepsy surgery: optimization of outcomes through functional MRI memory tasks and tailored surgeries.

Objective: The goal of epilepsy surgery is both seizure cessation and maximal preservation of function. In temporal lobe (TL) cases, the lack of functional MRI (fMRI) tasks that effectively activate mesial temporal structures hampers preoperative memory risk assessment, especially in children. This study evaluated pediatric TL surgery outcome optimization associated with tailored resection informed by an fMRI memory task.