ari Birth by Cesarean Delivery and Failure on First Otoacoustic Emissions Hearing Test By pediatrics.aappublications.org Published On :: 2012-06-11T00:08:09-07:00 Neonatal hearing screening occasionally fails because of several perinatal and neonatal factors. However, the effect of mode of delivery on hearing screening has not yet been established.We show significantly more failures on hearing screening in cesarean delivery infants. Hence, the timing of screening after cesarean delivery should preferably be postponed beyond 48 hours to improve success rate, minimize maternal anxiety, and decrease costs. (Read the full article) Full Article
ari Serotonin Transporter Role in Identifying Similarities Between SIDS and Idiopathic ALTE By pediatrics.aappublications.org Published On :: 2012-06-18T00:07:28-07:00 Literature about polymorphic expression of an apparent life-threatening event (ALTE), particularly that concerning discrimination between ALTE with evident cause and idiopathic ALTE, is scarce. Relationships between SIDS and ALTEs have been supposed but data are still controversial and no genetic data are available.Genetic analysis (5HTT and MAOA) on ALTEs and idiopathic ALTEs discriminated the 2 syndromes and found a link between the idiopathic form and SIDS. Consequently, we hypothesized that the 2 latter syndromes could be different phenotype expressions of a common genetic base. (Read the full article) Full Article
ari Racial Disparity Trends in Children's Dental Visits: US National Health Interview Survey, 1964-2010 By pediatrics.aappublications.org Published On :: 2012-07-02T00:07:36-07:00 Various studies have documented marked racial/ethnic disparities in children’s receipt of dental services at single time points or brief periods.This study reveals significant improvements in children’s receipt of dental care overall, as well as a dramatic narrowing of African American/white disparities in children’s receipt of dental services over the last 40 years in the United States. (Read the full article) Full Article
ari Academic Achievement Varies With Gestational Age Among Children Born at Term By pediatrics.aappublications.org Published On :: 2012-07-02T00:07:34-07:00 Late preterm infants are at risk for a variety of developmental impairments; however, little is known about developmental differences among children born within the term range of 37 to 41 weeks’ gestation.This study links comprehensive birth record data from 128 050 term births to children’s school records 8 years later. Analyses establish that, even among the "normal term" range, gestational age is an important independent predictor of academic achievement. (Read the full article) Full Article
ari Hypoxic and Hypercapnic Events in Young Infants During Bed-sharing By pediatrics.aappublications.org Published On :: 2012-07-16T00:07:03-07:00 Sudden infant death syndrome remains the major cause of postneonatal death in developed countries. Although infant-parent bed-sharing following antenatal smoking or maternal consumption of alcohol on the bed-sharing night increases the risk of death, the mechanism is not known.Bed-sharing infants experienced more oxygen desaturations and episodes of carbon dioxide rebreathing than cot-sleeping infants but showed appropriate behavioral and physiologic responses. A deficit in these responses in vulnerable infants could link to increased risk of sudden infant death syndrome. (Read the full article) Full Article
ari Risk Adjustment for Neonatal Surgery: A Method for Comparison of In-Hospital Mortality By pediatrics.aappublications.org Published On :: 2012-08-27T00:07:32-07:00 Evaluation of neonatal surgical outcomes is necessary to guide improvements in the quality of care. Meaningful comparisons must adjust for factors that alter outcomes independent of the surgical procedures.Herein is described a method that permits risk adjustment for the broad range of noncardiac neonatal surgery, regardless of gestational age, to permit useful comparisons for quality improvement. (Read the full article) Full Article
ari Comparison of Children Hospitalized With Seasonal Versus Pandemic Influenza A, 2004-2009 By pediatrics.aappublications.org Published On :: 2012-08-29T00:06:40-07:00 Although several studies have demonstrated increased morbidity and mortality with pH1N1 in children, others have found its clinical course to be similar to seasonal influenza. Moreover, most studies were conducted at single centers, thus raising concerns about generalizability of findings.This analysis provides national-level active hospital-based surveillance data comparing pH1N1 with 5 previous years of seasonal influenza A and demonstrates differences in risk factors and clinical presentation but not in ICU admission or mortality. (Read the full article) Full Article
ari Comparison of Mortality and Morbidity of Very Low Birth Weight Infants Between Canada and Japan By pediatrics.aappublications.org Published On :: 2012-09-10T00:07:52-07:00 Mortality of very low birth weight infants varies widely between regions and countries; however, the variation in morbidities after adjusting for confounders has not been adequately studied.Composite outcome of mortality or short-term morbidity for very low birth weight infants was lower in Japan than in Canada. However, marked variations in mortality and individual morbidity exist, revealing areas for improvement in each country. (Read the full article) Full Article
ari Variation in Occult Injury Screening for Children With Suspected Abuse in Selected US Children's Hospitals By pediatrics.aappublications.org Published On :: 2012-10-15T00:08:07-07:00 Clinical guidelines for the evaluation of suspected physical abuse in young children emphasize performing radiologic imaging to screen for occult fractures. Little is known about the degree of adherence to guidelines for screening for occult fractures among pediatric hospitals.Adherence to guidelines related to screening for occult fractures in young children diagnosed with physical abuse varies significantly among pediatric hospitals. Use of screening in infants who have injuries associated with a high likelihood of abuse also varies among pediatric hospitals. (Read the full article) Full Article
ari Variations in Children's Dental Service Use Based on Four National Health Surveys By pediatrics.aappublications.org Published On :: 2012-10-15T00:08:06-07:00 Oral health researchers and policy makers primarily use 4 national surveys to examine use of dental services among US children. Estimates from the surveys may vary, posing a challenge to population-based monitoring.The authors of this study compared estimates of dental service use and delayed dental care obtained from 4 commonly used health surveys to appraise their utility for guiding pediatric oral health research and policy. (Read the full article) Full Article
ari Comparison of One-Tier and Two-Tier Newborn Screening Metrics for Congenital Adrenal Hyperplasia By pediatrics.aappublications.org Published On :: 2012-10-15T00:08:05-07:00 The false-positive rate of newborn screening for classic congenital adrenal hyperplasia (CAH) remains high and has not been significantly improved by adjusting 17α-hydroxyprogesterone cutoff values for birth weight and/or gestational age. In response, 4 states have initiated second-tier steroid profile screening.Under second-tier screening, the false-positive rate remains high, and classic CAH cases missed by screening (false-negatives) occur more frequently than reported. Physicians are cautioned that a negative screen does not necessarily rule out CAH. (Read the full article) Full Article
ari Obesity Disparities Among Elementary-Aged Children: Data From School-Based BMI Surveillance By pediatrics.aappublications.org Published On :: 2012-11-12T00:08:28-08:00 Nationally representative surveys provide insight into overall childhood obesity trends and disparities but do not identify patterns specific to individual states. School-based surveillance is recommended, but it is unclear whether surveillance is helping to identify children at greatest risk.This study includes 3 consecutive years of surveillance findings to describe within-state spatial and socioeconomic disparities in obesity among elementary-aged children. Implications for states using and considering school-based surveillance to plan preventive interventions are considered. (Read the full article) Full Article
ari Expected Body Weight in Adolescents: Comparison Between Weight-for-Stature and BMI Methods By pediatrics.aappublications.org Published On :: 2012-11-12T00:08:24-08:00 In adolescents with eating disorders, percent expected body weight (EBW) is used for diagnosis and to make clinical decisions. The assumption is that the weight-for-stature (WFS) and BMI methods of determining EBW are equivalent, but that may not be true.This study demonstrates that EBWWFS is ~3.5% higher than EBWBMI. Differences are most pronounced at extremes of height. Compared with the EBWWFS method, sensitivity of EBWBMI to detect those <75% EBW is low. (Read the full article) Full Article
ari Disparities in Unmet Need for Care Coordination: The National Survey of Children's Health By pediatrics.aappublications.org Published On :: 2013-01-21T00:07:02-08:00 Care coordination has been proposed as a key mechanism for increasing quality and reducing costs of care. Little is known about the degree to which disparities exist in care coordination or whether having high-quality primary care attenuates disparities.A considerable proportion of parents reported unmet care coordination needs for their children, especially parents of children with special health care needs. Black and Latino children also may have more unmet needs because they received family-centered care less often. (Read the full article) Full Article
ari Disparities in Transition Planning for Youth With Autism Spectrum Disorder By pediatrics.aappublications.org Published On :: 2013-02-11T00:06:27-08:00 Health care transition services assist youth with special health care needs (YSHCN) in transitioning to adult care without gaps in services or health insurance coverage. Less than half of YSHCN receive anticipatory assistance in this transition; receipt of these services for youth with autism spectrum disorder is unknown.Youth with autism spectrum disorder receive transition services half as often as youth with special health care needs. Quality of health care is associated with increased receipt of health care transition services. Presence of comorbid conditions decreased receipt of transition services. (Read the full article) Full Article
ari Variation in the Use of Diuretic Therapy for Infants With Bronchopulmonary Dysplasia By pediatrics.aappublications.org Published On :: 2013-03-11T00:06:31-07:00 Diuretics are used in preterm infants to treat the symptoms of bronchopulmonary dysplasia (BPD), although there is little evidence of their effectiveness in improving long-term outcomes. Prescribing patterns and frequency of diuretic use in patients with BPD are unknown.The use of diuretics in infants with BPD, including the specific medications used and length of treatment, varies widely by institution. Long-term diuretic administration to patients with BPD is commonly practiced despite minimal evidence regarding effectiveness and safety. (Read the full article) Full Article
ari Prevalence and Reasons for Introducing Infants Early to Solid Foods: Variations by Milk Feeding Type By pediatrics.aappublications.org Published On :: 2013-03-25T01:07:29-07:00 Adherence to infant feeding recommendations in the United States is low. The prevalence of early introduction of solid foods (<4 months of age) in the United States has been estimated to range from 19% to 29%.Mothers’ most commonly cited reasons for early solid food introduction include perception of readiness, hunger, wanting to feed something in addition to breast milk or formula, perception of interest in solids, advice from a clinician, and to improve infant’s sleep. (Read the full article) Full Article
ari Long-term Effectiveness of Varicella Vaccine: A 14-Year, Prospective Cohort Study By pediatrics.aappublications.org Published On :: 2013-04-01T01:06:22-07:00 Varicella vaccine is known to be highly effective, with added benefit from a second dose.This study demonstrates the lasting effectiveness of varicella vaccine and the benefit of the second dose. Breakthrough varicella occurred soon after vaccination, varicella rates did not increase over 14 years, and there was no increase in zoster in the cohort. (Read the full article) Full Article
ari Galactose-{alpha}-1,3-galactose and Delayed Anaphylaxis, Angioedema, and Urticaria in Children By pediatrics.aappublications.org Published On :: 2013-04-08T00:06:53-07:00 Delayed anaphylaxis, urticaria, and angioedema to mammalian meat products were first described in the adult population in 2009. Patients with this syndrome who consume mammalian meat typically develop symptoms 4 to 6 hours after ingestion.Specific diagnoses for children who develop urticaria, angioedema, and idiopathic anaphylaxis are few and far between. We have now shown delayed anaphylaxis, urticaria, and angioedema due to mammalian meat products in the pediatric population. (Read the full article) Full Article
ari Disparities in Disability After Traumatic Brain Injury Among Hispanic Children and Adolescents By pediatrics.aappublications.org Published On :: 2013-05-06T00:07:32-07:00 Previous studies report Hispanic adults have lower access to rehabilitation services, especially among those who only speak Spanish, and higher disability after traumatic brain injury (TBI) compared with non-Hispanic white subjects. No studies have examined disparities in disability after TBI for Hispanic children.Hispanic children experience disparities in long-term disability after TBI. Compared with non-Hispanic white children, Hispanic children report significantly larger reductions in health-related quality of life, participation in activities, and ability to communicate and care for themselves 3 years after injury. (Read the full article) Full Article
ari Using Otoacoustic Emissions to Screen Young Children for Hearing Loss in Primary Care Settings By pediatrics.aappublications.org Published On :: 2013-06-03T00:06:59-07:00 The incidence of permanent hearing loss doubles between birth and school age. Otoacoustic emissions screening has been used successfully in early childhood educational settings to identify children with losses not found through newborn screening.Using otoacoustic emissions to screen the hearing of young children during routine health care visits is feasible and can lead to the identification of permanent hearing loss overlooked by providers relying solely on subjective methods. (Read the full article) Full Article
ari Racial and Ethnic Disparities in ADHD Diagnosis From Kindergarten to Eighth Grade By pediatrics.aappublications.org Published On :: 2013-06-24T00:07:08-07:00 Minority children are less likely than white children to be diagnosed and treated with attention-deficit/hyperactivity disorder. However, diagnosis patterns over time in early and middle childhood and whether confounding factors explain these disparities are not currently well understood.Racial/ethnic disparities in attention-deficit/hyperactivity disorder diagnosis occur by kindergarten and continue until eighth grade. Racial/ethnic disparities among diagnosed children in medication use occur in both fifth and eighth grades. These disparities are not attributable to confounding factors. (Read the full article) Full Article
ari Variation in Emergency Department Diagnostic Testing and Disposition Outcomes in Pneumonia By pediatrics.aappublications.org Published On :: 2013-07-22T00:07:44-07:00 There is wide variation in testing and treatment of children hospitalized with pneumonia. Limited data are available on diagnostic testing patterns and the association of test utilization with disposition outcomes for children with pneumonia evaluated in the emergency department (ED).Significant variation exists in testing for pediatric pneumonia. EDs that use more testing have higher hospitalization rates. However, ED revisit rates were not significantly different between high- and low-utilizing EDs, suggesting an opportunity to reduce testing without negatively affecting outcomes. (Read the full article) Full Article
ari Variation in Resource Use and Readmission for Diabetic Ketoacidosis in Children's Hospitals By pediatrics.aappublications.org Published On :: 2013-07-22T00:07:41-07:00 Diabetic ketoacidosis (DKA) is a short-term complication of type 1 diabetes and is a major cause of preventable hospitalization in children. Hospital resource utilization and readmission rates for DKA across the US are not known.Readmission for DKA within a year of hospitalization is common, accounting for one-fifth of all DKA admissions. Resource use, hospital length of stay, and readmission rates vary widely across major US children’s hospitals, even after adjusting for hospital differences in patients. (Read the full article) Full Article
ari Variation and Trends in ED Use of Radiographs for Asthma, Bronchiolitis, and Croup in Children By pediatrics.aappublications.org Published On :: 2013-07-22T00:07:43-07:00 Variation in the emergency department (ED) use of radiographs for asthma, bronchiolitis, and croup exists. Unnecessary radiographs contribute to higher costs of care, decreased ED efficiency, and increased radiation in children.Despite no changes in guidelines to support routine use, there is a significant upward trend in the use of radiographs for children with emergency department visits for asthma. Pediatric-focused EDs use significantly fewer radiographs for asthma, bronchiolitis, and croup. (Read the full article) Full Article
ari Disparities in Health Insurance Among Children With Same-Sex Parents By pediatrics.aappublications.org Published On :: 2013-09-16T01:07:11-07:00 Health insurance is associated with improved health for children, but gay and lesbian parents face barriers to adding their children to private health insurance. Little is known about the extent to which insurance disparities exist for children with same-sex parents.Children with same-sex parents are less likely to have private health insurance. When children live in states in which legal same-sex marriage, civil unions, domestic partnerships, or second-parent adoptions are available, disparities in private insurance diminish for children with same-sex parents. (Read the full article) Full Article
ari Impact of a Routine Two-Dose Varicella Vaccination Program on Varicella Epidemiology By pediatrics.aappublications.org Published On :: 2013-10-07T00:07:07-07:00 The 1-dose childhood varicella vaccination program in the United States resulted in dramatic declines in varicella incidence, hospitalizations, and deaths. There is little information on the impact of the 2006 recommendation for 2-dose varicella vaccination of children on varicella epidemiology.In the first 5 years of the 2-dose varicella vaccination program, declines in varicella incidence were seen in all age groups, including infants who are not eligible for varicella vaccination, providing evidence of the benefit of high population immunity. (Read the full article) Full Article
ari Frequency and Variety of Inpatient Pediatric Surgical Procedures in the United States By pediatrics.aappublications.org Published On :: 2013-11-25T00:07:06-08:00 Pediatric surgery is performed in a variety of hospital types. General surgeons as well as fellowship-trained pediatric surgeons and surgical subspecialists perform inpatient operative procedures on infants and children. The distribution of procedures between specialists is not well characterized.This study describes the demographics of pediatric surgery: the hospital type, the surgical procedures, and the quantity of inpatient pediatric surgery in the U.S. today. By implication, the data has much to inform health care about hospital and practitioner workforce. (Read the full article) Full Article
ari Disparities in Age-Appropriate Child Passenger Restraint Use Among Children Aged 1 to 12 Years By pediatrics.aappublications.org Published On :: 2014-01-13T00:07:00-08:00 Age-appropriate child safety seat use in the United States is suboptimal, particularly among children older than 1 year. Minority children have higher rates of inappropriate child safety seat use based on observational studies. Explanations for observed differences include socioeconomic factors.White parents reported greater use of age-appropriate child safety seats for 1- to 7-year-old children than nonwhite parents. Race remained a significant predictor of age-appropriate restraint use after adjusting for parental education, family income, and information sources. (Read the full article) Full Article
ari Variation in Quality of Tonsillectomy Perioperative Care and Revisit Rates in Children's Hospitals By pediatrics.aappublications.org Published On :: 2014-01-20T00:06:48-08:00 Tonsillectomy is one of the most commonly performed surgeries in children and is one of the most cumulatively expensive conditions in pediatric hospital care. Little is known about how the quality of tonsillectomy care varies across hospitals.In a large cohort of low-risk children undergoing same-day tonsillectomy, there was substantial variation in quality measures of process, dexamethasone and antibiotic use, and outcome, revisits to the hospital within the first 30 days after surgery. (Read the full article) Full Article
ari Role of Financial and Social Hardships in Asthma Racial Disparities By pediatrics.aappublications.org Published On :: 2014-02-02T06:31:53-08:00 Asthma morbidity disproportionately affects racial minorities and disadvantaged children. Differences in socioeconomic status and genetics have been offered as explanations but an in-depth understanding of differences in hardships may better explain disparities and also help to identify intervention targets.Among children admitted for asthma, African Americans were twice as likely to be readmitted as whites. Nearly half the disparity was explained by socioeconomic status and hardships. Community-based interventions targeting hardships may be more feasible given emerging health care payment reform. (Read the full article) Full Article
ari Dental Caries and Growth in School-Age Children By pediatrics.aappublications.org Published On :: 2014-02-17T00:07:19-08:00 There is conflicting evidence about the relationship between dental caries in primary teeth and children’s height and weight.Findings reveal an inverse linear association between caries levels and children’s height and weight. The findings take the argument beyond the presence or absence of an association and provide a better understanding of the pattern of this association. (Read the full article) Full Article
ari Variation in Congenital Heart Surgery Costs Across Hospitals By pediatrics.aappublications.org Published On :: 2014-02-24T00:07:07-08:00 Congenital heart disease is known to be a commonly treated and resource-intense condition across children’s hospitals, yet knowledge regarding the degree of cost variation across hospitals and associated factors is lacking.Using a linked clinical and administrative data set, we establish benchmarks for hospital costs for common congenital heart operations, and demonstrate wide variation in cost between hospitals related in part to differences in length of stay and complications. (Read the full article) Full Article
ari Pediatric Data Sharing in Genomic Research: Attitudes and Preferences of Parents By pediatrics.aappublications.org Published On :: 2014-03-10T00:06:25-07:00 We previously reported that parents of children enrolled in genomic research made more restrictive data sharing (DS) decisions than adults. The ethics of pediatric DS have been discussed, but reasons for differences in decision-making have not been explored.We present an empirically based discussion of attitudes toward and preferences for DS obtained from structured interviews of adult patients and parents of pediatric patients enrolled in genomic research studies. Parents expressed more concern about future risks than adult participants. (Read the full article) Full Article
ari Office-Based Preventive Dental Program and Statewide Trends in Dental Caries By pediatrics.aappublications.org Published On :: 2014-03-31T00:06:57-07:00 Guidelines recommend that primary care physicians provide preventive dental services to young children. Most state Medicaid programs reimburse physicians for providing fluoride varnish. Individual-level studies show that these services are effective in reducing caries-related treatments and costs.Preventive dental services provided through a North Carolina Medicaid preventive dental program led to a reduction in dental caries among young children statewide. Programs targeting vulnerable populations through medical offices can reduce disparities in oral health among preschool-aged populations. (Read the full article) Full Article
ari Variations in Measurement of Sexual Activity Based on EHR Definitions By pediatrics.aappublications.org Published On :: 2014-04-14T00:07:34-07:00 The use of electronic health record systems to measure adolescent health care quality requires an operational definition of sexual activity for measuring recommended health promotion activities such as Chlamydia screening and others related to reproductive health.This study is the first to compare operational definitions of sexual activity by using information electronically abstracted from electronic health records of adolescent females. Our research supports the use of broader operational definitions of sexual activity for health quality measurement. (Read the full article) Full Article
ari Prenatal Vitamin D and Dental Caries in Infants By pediatrics.aappublications.org Published On :: 2014-04-21T00:06:58-07:00 Many young children are at risk for caries, which is the most common chronic disease of childhood. As primary teeth begin to develop in utero, prenatal influences are believed to affect the integrity of enamel and subsequent resistance to decay.This study shows, for the first time, that maternal prenatal 25-hydroxyvitamin D levels may have an influence on the primary dentition and the development of early childhood caries. Specifically, lower levels are associated with increased risk of caries in infants. (Read the full article) Full Article
ari Common Genetic Variants and Risk of Brain Injury After Preterm Birth By pediatrics.aappublications.org Published On :: 2014-05-12T00:06:51-07:00 Preterm birth is strongly associated with alterations in brain development and long-term neurocognitive impairment that are not fully explained by environmental factors.Common genetic variation in genes associated with schizophrenia and lipid metabolism modulates the risk for preterm brain injury; known susceptibilities to neurologic disease in later life may be exposed by the stress of preterm birth. (Read the full article) Full Article
ari Preparing Adolescents With Chronic Disease for Transition to Adult Care: A Technology Program By pediatrics.aappublications.org Published On :: 2014-05-19T00:06:58-07:00 Adolescents with chronic disease are a diverse population with common needs for transition. Disease-specific interventions have shown promise at improving patient outcomes but with substantial personnel and resource costs. Whether a generic approach across diseases may be useful is unknown.This study is among the first to evaluate a generic (across disease) approach to transition of adolescents to adult care. The approach demonstrated promise and cost savings due to reduced personnel requirement and use of low-cost technology dissemination methods. (Read the full article) Full Article
ari Variation in Outcomes of Quality Measurement by Data Source By pediatrics.aappublications.org Published On :: 2014-05-26T00:07:47-07:00 Administrative health insurance claims have limitations when measuring care quality.Children’s care quality measures assessed using administrative claims alone may not accurately reflect care quality. Use of electronic health record data in combination with administrative claims data provides an opportunity for more complete measurement. (Read the full article) Full Article
ari Comparison of Rapid Cranial MRI to CT for Ventricular Shunt Malfunction By pediatrics.aappublications.org Published On :: 2014-06-02T00:06:39-07:00 Rapid cranial MRI is a radiation-free method to assess children with possible ventricular shunt malfunction. However, the test performance of rapid cranial MRI has never been compared with that of cranial CT, the current reference standard.The accuracy of rapid cranial MRI was not inferior to that of CT for diagnosing ventricular shunt malfunction. Rapid cranial MRI is an important radiation-sparing diagnostic alternative for children presenting emergently with possible ventricular shunt malfunction. (Read the full article) Full Article
ari Disparities in Early Exposure to Book Sharing Within Immigrant Families By pediatrics.aappublications.org Published On :: 2014-06-02T00:06:37-07:00 Parents in disadvantaged households are less likely to book share with their children during early childhood. These children are more likely to enter school with delays in emergent literacy and language skills, apparent as early as the age of 3.This study examines the effect of parental immigrant status as a predictor of reading and sharing books with children. This research disentangles immigrant status from other variables thought to explain disparities in familial practices related to emergent literacy. (Read the full article) Full Article
ari Impact of Vaccination on the Epidemiology of Varicella: 1995-2009 By pediatrics.aappublications.org Published On :: 2014-06-09T00:06:37-07:00 Varicella vaccine is effective, but there is concern that widespread use in young children may lead to a shift in the age of infection, with potentially more severe disease later in childhood and adolescence.This study documents that varicella vaccine resulted in a decline of varicella incidence and hospitalization in all age groups, with no shift to older age groups. (Read the full article) Full Article
ari Variability in IRBs Regarding Parental Acceptance of Passive Consent By pediatrics.aappublications.org Published On :: 2014-07-07T05:07:03-07:00 Passive or opt-out consent has been successfully used to recruit subjects in several investigational studies. However, institutional review boards are often inconsistent in their application of federal regulations regarding passive consent.This study documented the variability among 24 local institutional review boards in their application of federal regulations regarding passive consent and parental acceptance of a passive consent strategy in a multicenter pediatric study. (Read the full article) Full Article
ari Variation in Emergency Department Admission Rates in US Children's Hospitals By pediatrics.aappublications.org Published On :: 2014-08-11T00:06:56-07:00 There is substantial variation in the medical care provided to pediatric patients across diverse clinical settings. This variation raises concerns about whether every patient is receiving optimal care and whether more standardized approaches around clinical decisions are needed.We observed wide variation in admission rates for common pediatric conditions across US children’s hospitals. Our findings highlight the need for greater focus on the standardization of decisions regarding hospitalization of patients presenting to the emergency department. (Read the full article) Full Article
ari Small Geographic Area Variations in Prescription Drug Use By pediatrics.aappublications.org Published On :: 2014-08-11T00:06:54-07:00 Prescribing patterns in the US pediatric population are changing but not uniformly. A detailed examination of prescription variation is needed to better understand pharmacotherapy of children and to inform future exploration of the causes and consequences of diverse practices.We examine pediatric pharmacotherapy and quantify payer type differences and small geographic area variation. Substantial payer-type differences and regional variations were found, likely reflecting local practice cultures. Variation was greatest for medications used in situations of diagnostic and therapeutic uncertainty. (Read the full article) Full Article
ari Variation in Care of the Febrile Young Infant <90 Days in US Pediatric Emergency Departments By pediatrics.aappublications.org Published On :: 2014-09-29T00:06:47-07:00 Various low-risk criteria have been developed to guide management of the febrile young infant (<90 days), but they differ in age criteria, recommendations, and implementation. Therefore, variation in care is likely but has not been previously studied.There is wide variation in testing, treatment, and overall resource utilization in management of the febrile young infant across all 3 age groups: ≤28, 29 to 56, and 57 to 89 days. There may be opportunities to improve care variation without compromising outcomes. (Read the full article) Full Article
ari Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study By pediatrics.aappublications.org Published On :: 2014-10-20T00:06:36-07:00 Quality improvement (QI) studies generally do not account for concurrent trends of improvement and it is difficult to distinguish the impact of a multihospital collaborative QI project without a contemporary control group.A multihospital collaborative QI model led to greater declines in hypothermia and invasive ventilation rates in the delivery room compared with an individual NICU QI model and NICUs that did not participate in formal QI activities. (Read the full article) Full Article
ari Use of and Regional Variation in Initial CT Imaging for Kidney Stones By pediatrics.aappublications.org Published On :: 2014-10-27T00:06:34-07:00 Professional organizations recommend ultrasound as the initial diagnostic imaging modality for children with suspected nephrolithiasis. Computed tomography utilization for children with nephrolithiasis treated at freestanding children’s hospitals is common and varies substantially by hospital.The high prevalence and regional variability of CT as the first imaging study for children with nephrolithiasis who presented to emergency departments, outpatient clinics, and hospitals throughout the United States indicate that current imaging practices deviate substantially from guidelines. (Read the full article) Full Article
ari Variability in ADHD Care in Community-Based Pediatrics By pediatrics.aappublications.org Published On :: 2014-11-03T00:06:30-08:00 In 2000/2001, the American Academy of Pediatrics published recommendations for attention-deficit/hyperactivity disorder (ADHD) care. According to pediatricians’ self-report of adoption of these guidelines, community-based ADHD care appears to be marginally adequate.Using reviews of >1500 patient charts, this study demonstrates that community-based ADHD care is not consistent with evidence-based practice. Furthermore, variability in much of community-based ADHD care is unrelated to the provider, suggesting that innovative, system-wide interventions are needed to improve ADHD care. (Read the full article) Full Article