A5009027574- Sepsis Diagnosis and Treatment
- Emergency and Acute Care Studies
- Nosocomial Infections in ICU
- Electronic Health Records Systems
- Traumatic Brain Injury Research
- Cardiac Arrest and Resuscitation
- Neonatal and Maternal Infections
- Clinical Reasoning and Diagnostic Skills
- Hemodynamic Monitoring and Therapy
- Patient Safety and Medication Errors
- Airway Management and Intubation Techniques
- Traumatic Brain Injury and Neurovascular Disturbances
- Tracheal and airway disorders
- Clinical Nutrition and Gastroenterology
- Ultrasound in Clinical Applications
- Family and Patient Care in Intensive Care Units
- Childhood Cancer Survivors' Quality of Life
- Trauma and Emergency Care Studies
- Renal function and acid-base balance
- Central Venous Catheters and Hemodialysis
- Innovations in Medical Education
- Healthcare Decision-Making and Restraints
- Cardiac, Anesthesia and Surgical Outcomes
- Foreign Body Medical Cases
- Musculoskeletal pain and rehabilitation
Boston Children's Hospital
2016-2025
Harvard University
2016-2025
University of Nevada, Las Vegas
2023
Stanford Health Care
2021-2022
Boston Children's Museum
2020-2021
UC Davis Health System
2021
Stanford University
2015
Seattle Children's Hospital
2006
OBJECTIVES: To examine the incidence, duration, and clinical course of individual post-concussive symptoms in patients presenting to a pediatric emergency department (ED) with concussion. METHODS: We conducted secondary analysis prospective cohort study 11 22 years old ED children’s hospital an acute The main outcome measure was duration symptoms, assessed by Rivermead Post-Concussion Symptoms Questionnaire (RPSQ). Patients initially completed questionnaire describing mechanism injury,...
To test the hypothesis that children with a previous history of concussion have longer duration symptoms after repeat than those without such history.Prospective cohort study consecutive patients 11 to 22 years old presenting emergency department children's hospital an acute concussion. The main outcome measure was time symptom resolution, assessed by Rivermead Post-Concussion Symptoms Questionnaire (RPSQ). Patients and providers completed questionnaire describing mechanism injury,...
Abstract Background Diagnostic test evaluation requires a reference standard. We describe an approach for creating standard acute infection using unrestricted adjudication and apply it to compare biomarker tools. Methods Adults children with suspected enrolled in three prospective studies at emergency departments urgent cares were included. Adjudicators, blinded C-reactive protein, procalcitonin, MeMed BV (MMBV), labeled each case (bacterial/viral/non-infectious/indeterminate). Initial...
Our goal was to determine if there were any changes in risk-adjusted mortality after the implementation of a computerized provider order entry system our PICU.Study undertaken tertiary care PICU with 20 beds and 1100 annual admissions. Demographic, admission source, primary diagnosis, crude mortality, Pediatric Risk Mortality III abstracted retrospectively on all admissions from PICUEs database for period October 1, 2002, December 31, 2004. This time reflects 13 months before implementation....
Importance There is no consensus and wide practice variation in the choice of initial vasoactive agent children with septic shock. Objective To determine whether receipt epinephrine compared norepinephrine as first medication administered associated improved outcomes among shock without known cardiac dysfunction. Design, Setting, Participants This single-center, retrospective cohort study used propensity score matching to examine encounters which a patient was diagnosed required infusion...
Importance Pediatric consensus guidelines recommend antibiotic administration within 1 hour for septic shock and 3 hours sepsis without shock. Limited studies exist identifying a specific time past which delays in are associated with worse outcomes. Objective To determine point that is increased risk of mortality among pediatric patients sepsis. Design, Setting, Participants This retrospective cohort study used data from 51 US children’s hospitals the Improving Sepsis Outcomes collaborative....
The objective was to compare video-assisted laryngoscopy (VAL) direct (DL) on success rate and complication of intubations performed in a pediatric emergency department (ED).This is retrospective cohort study attempted children aged 0-18 years ED between 2004 2014 with first attempt by an provider. In VAL, the laryngoscopist attempts visualization glottis C-MAC video laryngoscope while monitor used for real-time guidance supervisor, back-up should view be inadequate, confirmation...
Abstract Background/aims Despite evidence that preferential use of balanced/buffered fluids may improve outcomes compared with chloride-rich 0.9% saline, saline remains the most commonly used fluid for children septic shock. We aim to determine if resuscitation as part usual care will outcomes, in through reduced kidney injury and without an increase adverse effects, Methods The Pragmatic Pediatric Trial Balanced versus Normal Saline Fluid Sepsis (PRoMPT BOLUS) study is international,...
Pediatric emergency department (ED) visits for concussion have nearly tripled in the past decade. Despite this, there are limited bedside tools available to objectively diagnose injury and prognosticate recovery. Here, we perform a preliminary evaluation of utility glial fibrillary acidic protein (GFAP) predicting initial follow-up symptom burden children young adults 11-21 years age, presenting ED after concussion. We enrolled 13 within 24 h concussion, obtained serum samples at that time...
Demonstrating the value of spine care requires adequate outcomes assessment. Long-term are best measured as overall improvement in quality life (QOL) after surgical intervention. Present registries often require parallel data entry, introducing inefficiencies and limiting compliance. The authors detail methodology constructing an integrated electronic health record (EHR) system to collect QOL metrics demonstrate effect collection on routine clinical workflow. A streamlined approach...
To create and evaluate a continuous automated alert system embedded in the electronic health record for detection of severe sepsis among pediatric inpatient emergency department patients.Retrospective cohort study. The main outcome was algorithm's appropriate sepsis. Episodes were identified by chart review encounters with clinical interventions consistent treatment, use diagnosis code sepsis, or deaths. algorithm initially tested based upon criteria International Pediatric Sepsis Consensus...
BACKGROUND AND OBJECTIVES The Phoenix criteria for pediatric sepsis and septic shock have recently been proposed worldwide application. are based on organ dysfunction scoring. Although many screening tools exist, their performance in predicting outcomes is not known. We hypothesized that the quick Pediatric Septic Shock Screening Score (qPS4) would demonstrate greater sensitivity compared with Liverpool Sequential Organ Failure Assessment (LqSOFA) a commonly used 2-stage tool created at...
Background The Child Opportunity Index (COI) is a multidimensional measure of US neighbourhood-level conditions needed for healthy development. COI associated with healthcare delivery and outcomes. Formal quality improvement (QI) may influence the relationship between COI, care outcomes in children. Objective To assess association paediatric sepsis determine if baseline disparities change over time among hospitals Improving Pediatric Sepsis Outcomes (IPSO) collaborative. Methods...
The objective of this study was to define the test characteristics cardiac troponin T (cTnT) in pediatric patients who presented with suspected myocarditis.We performed a retrospective cohort all at large urban children's hospital 21 years or younger had cTnT sent for evaluation myocarditis over 13-month period. Patients were excluded if they any history heart disease arrest before presentation, reasons other than concern myocarditis. Positive cases defined by characteristic pathology...
OBJECTIVES: To compare the performance and test characteristics of an automated sepsis screening tool with that a manual screen in patients presenting to pediatric emergency department (ED). METHODS: We conducted retrospective cohort study encounters ED over 2-year period. The algorithm replaced 1 year into study. A positive case was defined as development severe or septic shock within 24 hours disposition from ED. calculated sensitivity, specificity, predictive value (PPV), negative (NPV),...
To compare the accuracy of computer versus physician predictions hospitalization and to explore potential synergies hybrid physician-computer models.A single-center prospective observational study in a tertiary pediatric hospital Boston, Massachusetts, United States. Nine emergency department (ED) attending physicians participated study. Physicians predicted likelihood admission for patients ED whose disposition had not yet been decided. In parallel, random-forest model was developed predict...
Prescription errors are a significant cause of iatrogenic harm in the health care system. Pediatric emergency department (ED) patients particularly vulnerable to error. We sought decrease prescription an academic pediatric ED by 20% over 24-month period implementing identified national best practice guidelines.From 2017 2019, multidisciplinary, fellow-driven quality improvement (QI) project was conducted using Model for Improvement. Four key drivers were including simplifying electronic...
Children with intestinal failure (IF) on parenteral nutrition (PN) are at high risk for bacteremia, and delays in antibiotic administration have been associated increased morbidity mortality. We designed an emergency department (ED) quality improvement (QI) initiative to reduce time of intravenous antibiotics febrile children IF PN.Our aim was decrease the mean PN receive by 50% <60 minutes over a 12-month period. Secondary outcome measures were ED, hospital, ICU length stay (LOS). Our...
Abstract Background: Diagnostic error can lead to increased morbidity, mortality, healthcare utilization and cost. The 2015 National Academy of Medicine report “Improving Diagnosis in Healthcare” called for improving diagnostic accuracy by developing innovative electronic approaches reduce medical errors, including missed or delayed diagnosis. objective this article was develop a process detect potential discrepancy between pediatric emergency inpatient discharge diagnosis using...