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PubMed1993

Cessation of unsuccessful pediatric resuscitation--how long is too long?

Emergency teams asked to provide cardiopulmonary resuscitation for pediatric patients often consist of nurses and physicians from various pediatric and nonpediatric specialties. Team members should agree on the timing of termination of unsuccessful resuscitative efforts; however, no firm guidelines about such timing have been established. The purposes of this study were to determine (1) whether a consensus exists among health-care professionals about the optimal duration of unsuccessful resuscitation for pediatric patients and (2) whether attitudes are influenced by individual case prognosis, medical specialty, level of training, or certification in pediatric advanced life support (PALS). By random selection, 140 physicians, nurses, and medical students were asked to specify the duration that they would continue unsuccessful resuscitative efforts for each of two hypothetical cases: one patient with a good prognosis for survival and one with a poor prognosis. Although no clear consensus existed, all groups of health-care providers chose significantly briefer durations of resuscitation for the case with a poorer prognosis (P < 0.01). The specified durations of resuscitation were briefer for those who had PALS certification than for those who did not and for pediatricians than for nonpediatric physicians (P < 0.01). Furthermore, PALS certification (P < 0.01) and pediatric specialty (P < 0.05) contributed as independent variables in influencing the study participants' attitudes about duration of resuscitation, whereas level of training did not. We conclude that no consensus exists among the groups studied on the optimal duration of unsuccessful resuscitative efforts in pediatric patients. We speculate that the opinions might be more uniform if resuscitation of pediatric patients was provided primarily by pediatricians or PALS-certified physicians.

Attitude of Health Personnel↗
PubMed2000

Nicotine replacement prescription practices of obstetric and pediatric clinicians.

OBJECTIVE: To assess smoking cessation counseling and nicotine replacement therapy prescription and recommendation practices among obstetric and pediatric providers. METHODS: We sent out a self-administered survey to 61 obstetric and pediatric nurse practitioners and physicians at six community health centers in the Boston area. RESULTS: Obstetric providers were more likely to view smoking cessation counseling as their responsibility in treating pregnant women than pediatric providers did in treating infants with mothers who smoked (mean +/- standard deviation [95% confidence interval] 4.5 +/- 0.76 [4.2, 4.8] versus 4.0 +/- 0.8 [3.7, 4.3] on a five-point scale; P <.05). Obstetric providers believed that smoking cessation counseling was more effective than did pediatric providers (3.45 +/- 1.1 [3.0, 3.9] versus 2.8 +/- 0.8 [2.5, 3.1] on a five-point scale; P <.05) and were more likely to report provision of cessation assistance than pediatric providers (63% [44%, 82%] versus 17% [5%, 29%]; P <.05). Obstetric providers were more likely to prescribe or recommend over-the-counter nicotine replacement therapy than pediatric providers (44% [25%, 63%] versus 11% [1%, 21%], P =.004). Reasons for not prescribing nicotine replacement differed according to specialty; however, perceived lack of efficacy was not a typical reason given by clinicians in either specialty. Only two of 47 practitioners who did not prescribe or recommend those therapies listed that as a factor in their decisions. CONCLUSION: We found that nicotine replacement therapies are commonly prescribed or recommended to pregnant smokers by obstetric providers, but less commonly to lactating women by pediatric providers.

Adult↗
PubMed1997

Safe pediatric outpatient sedation: the chloral hydrate debate revisited.

Diagnostic imaging in the pediatric patient frequently requires sedation. The use of chloral hydrate, the standard agent for many years, has recently come under severe scrutiny. The American Academy of Pediatrics (AAP) published guidelines for the elective sedation of pediatric patients; however, compliance with the AAP guidelines is not compulsory. A review of the medical literature shows a wide range of medications used for pediatric sedation, along with a diversity in the protocols available for monitoring the cardiopulmonary status of the patient. When ordering computed tomography and magnetic resonance imaging scans, pediatric otolaryngologists indirectly are exposing their patients to the sedation practices and monitoring protocols of their referral imaging center. A questionnaire regarding the sedation protocol for routine, outpatient, computed tomography or magnetic resonance imaging scans in children aged 5 years or younger was sent to staff radiologists at 36 pediatric medical centers throughout the United States. A variety of sedation practices were elicited. The complete survey results are presented, including monitoring practices, complication, and success rates. Despite concerns about its safety, chloral hydrate remains a frequently used and safe method of pediatric outpatient sedation.

Ambulatory Care↗
PubMed2000

[Management of adolescents in pediatric hospitals. A national survey].

UNLABELLED: Hospital care of adolescents is a challenge for pediatric teams because of the characteristics and specific problems of this age group. METHODS: In 1996, a questionnaire was sent to all French public pediatric wards, 300 (i.e., 78%) of which participated. The goal of this survey was to investigate the facts and limitations encountered with hospitalization of patients 12 years and older. RESULTS: Data show that for more than half of the pediatric wards, the adolescent patient admission rate is higher than 10%. The upper age for hospitalization shows a shift towards adulthood, with 73% of the wards admitting adolescents up to 18 years of age. The main reasons for pediatric admission in this age group are somatic complaints, chronic diseases and suicide attempts. Psychosocial problems and psychiatric disorders are perceived as the most difficult to manage. However, a majority of pediatric wards appears to have an environment suitable for multidisciplinary networking. At the time of the survey, 39 wards (16%) had beds specifically destined for adolescents. These wards differed from others by their higher number of suicidal and anorexic inpatients. CONCLUSIONS: Our study shows that pediatric wards are in the avant-garde of adolescent hospital care and it brings new data on the various problems encountered in these patients. It stresses the special needs of pediatric teams today in the field of adolescent medicine and calls for the development of specific educational programs.

Adolescent↗
PubMed2004

[Emergency departments: pediatric quality indicators as guide to quality assurance].

INTRODUCTION: Measuring the quality of care in emergency departments requires tools to quantify the most important aspects in the care process. The quality indicator is the quantitative measure used in quality assurance. OBJECTIVES: To review the document created by the Catalan Society of Emergency Medicine (SCME) and the Avedis Donabedian Foundation (FAD) in which the quality indicators for the emergency departments were established and to incorporate their methodology and select the indicators that could be adapted to pediatric emergencies. To add new indicators that, in the opinion of experts in pediatric emergencies, could be useful in daily pediatric care. To agree on the definitive list of indicators for use in pediatric emergencies and to define those that will be considered the main indicators. To develop a document on behalf of the Spanish Society of Pediatric Emergencies (SEUP), which will serve as a reference in quality of care. MATERIAL AND METHODS: In the first stage, a Working Group of the SEUP was formed. The SCME/FAD paper was distributed after exclusion of the indicators that were not applicable to children. Each member adapted the indicators and proposed others. The Working Group then chose a set of indicators considered essential in any pediatric emergency department. RESULTS: The final document has 89 indicators, each with the following parameters: dimension, justification, ratio, explanation of terms, population, type, sources of information, standard and comments. Depending on the content, they are classified in one of the following sections: diseases, activities and work areas. Eighteen indicators were adapted to the pediatric age group. Twenty new indicators were added and 12 were proposed as basic or essential. CONCLUSIONS: The quality indicators are useful in measuring concrete and specific aspects of clinical care and in providing information on quality. The indicators provide valid, reliable and objective information. The indicator is an early warning sign to identify areas requiring improvement and allows appropriate measures to be taken to correct the detected deficiencies. The use of indicators allows comparisons with uniform criteria to be made.

Emergency Service, Hospital↗
PubMed2000

A comparison of long pediatric hospitalizations in 1985 and 1994.

The objective of this study was to identify pediatric conditions commonly resulting in long hospitalizations, to evaluate changes in hospital use for these conditions over a 9-year period, and to describe the characteristics of children hospitalized for long periods (longer than 7 days). To accomplish this purpose we conducted a population-based, descriptive analysis of pediatric hospitalizations for children aged 1 to 12 years in California in 1985 and 1994 using hospital discharge data. We found that hospitalizations of longer than 7 days accounted for 10.8% of pediatric hospitalizations in 1985 (58.4% of pediatric hospital days) and 11.8% of hospitalizations in 1994 (50.4% of hospital days). Rates of long pediatric hospitalization decreased from 312.1/100,000 children in 1985 to 236.4/100,000 children in 1994. Rates fell for both sexes, in all racial/ ethnic groups, and among both preschool-age and school-age children. Common reasons for long hospitalizations in both 1985 and 1994 included lower-limb fractures, pneumonia, appendicitis, and malignancies. The rate of long hospitalization for mental disorders increased by 57% between 1985 and 1994, while the rate for injuries and poisoning decreased by 38%. In summary, long pediatric hospitalizations in 1985 and 1994 accounted for under 12% of all hospitalizations of children but for more than 50% of all hospital days. Although the overall rate of long pediatric hospitalizations decreased, rates for certain conditions, notably mental disorders, increased. As states continue to implement major health care changes, further study of conditions among children that account for a large proportion of hospital days is warranted.

Age Distribution↗
PubMed2025

Establishing a national pediatric stem cell transplantation registry in Iran addressing implementation and data quality challenges.

The Iranian Pediatric Hematopoietic Stem Cell Transplantation Registry (IPED-HSCT) was established to enhance data collection, improve patient outcomes, and support clinical research in pediatric hematopoietic stem cell transplantation. This study aimed to assess the feasibility and reliability of implementing a standardized registry in pediatric settings. A community-based participatory study was conducted across three pediatric HSCT centers in Iran. The registry development involved a multi-phase approach, including pilot testing and the implementation of a web-based system. Data were collected from fifty pediatric patients who underwent HSCT for both malignant and non-malignant conditions, with a focus on data completeness and user satisfaction. Statistical analyses were performed using IBM SPSS Statistics. The registry achieved a data completeness rate exceeding 90%, with a participant demographic of 31 males (62%) and 19 females (38%). Rigorous quality control measures and real-time validation rules were implemented, enhancing data reliability. User feedback indicated high satisfaction with the platform's design and training sessions. Challenges included variations in long-term follow-up data collection across centers. The IPED-HSCT Registry demonstrates that establishing a robust pediatric HSCT registry is feasible even in resource-limited settings. Its innovative features offer a scalable model for similar initiatives in developing countries. Future research should focus on ensuring long-term sustainability and fostering international collaborations to improve pediatric HSCT outcomes globally. not applicable.

Humans↗
PubMedDate not supplied

A living legend in pediatric oncology nursing: Jean Fergusson. Interview by Kathy Ruccione.

Jean Fergusson is a true pioneer in pediatric oncology nursing. Her many professional accomplishments include working alongside Dr. Sidney Farber and others in the first pediatric Tumor Therapy Clinic in the United States, establishing a model pediatric nurse practitioner program that graduated an influential cadre of pediatric oncology nurse practitioners, publishing landmark papers about late sequelae of childhood cancer treatment, and serving as a role model and mentor to countless nurses over the past 50 years. Jean has brought all she is to her life as a nurse-she is gentle, funny, wise, easily moved, curious, generous, and, most of all, she truly loves children. An eyewitness to the dramatic changes in pediatric oncology over the decades, she herself is a survivor, having overcome dyslexia and other daunting life challenges. In this interview, Jean responds to questions about what shaped her interest in nursing and how she chose pediatric oncology, her impressions and recollections of the early days in pediatric oncology nursing, and her vision for the future of our specialty.

Humans↗
PubMed2006

[Quality control of thoracic X-rays in children in diagnostic centers with and without pediatric-radiologic competence].

PURPOSE: Radiation protection in pediatric radiology is very important because of the particular sensitivity of radiosensitive organs in younger patients. Optimized image quality supports radiation protection and should be targeted. In our study we examined the quality of pediatric chest X-rays at diagnostic centers (university hospitals and other large clinics). We then evaluated differences in image quality in departments without pediatric competence (R) and departments with pediatric competence (PR). MATERIALS AND METHODS: Our study was based on 313 conventional chest X-rays from 207 patients (192 p. a./a. p. and 121 lateral, 43 from R, 258 from PR and 12 neither from R nor KR) and 38 digital chest X-rays from 26 patients (25 p. a./a. p. and 13 lateral, 1 from R and 37 from PR). All patients (age 0 - 18 years) are from Nephroblastoma-Study SIOP-93/01-GPOH. We examined all initial chest X-rays, which were sent to us for evaluation upon request between 4/3/2002 and 6/14/2002. The examined parameters were: exposure, centering of the X-rays/patient positioning, collimation and sharpness. The X-rays were evaluated on a scale from 1 (best result) to 5 (worst result), resulting in an overall score of A = optimum, B = minor problems, C = major problems, or D = unusable. The optical density, the center of the image and the relative field size were also measured. Statistical tests (Mann-Whitney-U and log regression) were carried out on the conventional images. The study was performed retrospectively. The exposure, sharpness and optical density of the digital X-rays were not analyzed. RESULTS: In the case of all conventional X-rays, the quality of the centering of the X-rays/patient positioning and collimation was moderate (average scale value: 2.4 and 2.8), and the quality of the exposure and sharpness was good and very good (average scale value: 1.9 and 1.5). The quality of the chest X-rays in departments with additional pediatric radiological expertise was better mainly in the case of younger patients (younger than 5 years) than departments without additional pediatric radiological expertise (average scale value in age group 0 - 1 month: PR = 1.7; average scale value in age group 2 months - 2 years: R = 2.4 and PR = 1.8; average scale value in age group 3 - 5 years: R = 2.5 and PR = 1.8). CONCLUSION: Despite the good overall image quality, the quality of the centering of the X-rays/patient positioning and collimation was insufficient in both examiner groups (R and PR). For this reason, some radiation protection requirements could not be fulfilled. X-rays from PR were higher quality than X-rays from R in this special study group. Day-to-day quality checks are necessary for pediatric chest X-rays in order to achieve a high quality standard.

Adolescent↗
PubMed2026

Long-term mortality in pediatric sepsis: a systematic review and meta-analysis.

BACKGROUND: Pediatric sepsis represents a significant factor in the mortality rates among children, with survivors remaining highly fragile during the period following discharge. While in-hospital and short-term mortality have been widely studied, the long-term mortality of pediatric sepsis is not adequately synthesized or appreciated. This study aims to estimate the long-term mortality associated with pediatric sepsis, providing a basis for optimizing post-discharge surveillance and care protocols. METHODS: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251137504). Exhaustive searches were conducted in PubMed, Embase, the Cochrane Library, and Web of Science for studies published from the inception of each database to June 30, 2025. Studies reporting long-term mortality in pediatric sepsis patients diagnosed using international consensus criteria were included. After literature screening, long-term mortality was pooled using a random effects meta-analysis in R statistical software. RESULTS: A total of 72,065 records were identified through database searching. After removing duplicates and screening, six studies comprising 11,318 pediatric sepsis patients were included. The pooled long-term mortality in pediatric sepsis was 11% (95% CI: 7-16%), though significant heterogeneity was observed (I2 = 98.2%, p&#x2009;<&#x2009;0.001). Sensitivity analyses yielded similar results, and evidence of publication bias was limited. CONCLUSION: Long-term mortality after pediatric sepsis was 11%, highlighting the persistent risk of mortality after hospital discharge. Further high-quality longitudinal studies are required to identify modifiable risk factors and guide evidence-based follow-up and personalized care.

Humans↗
PubMed1986

Evaluation of pediatric oncology objectives developed by the American Association for Cancer Education.

Educational objectives in pediatric oncology for medical students developed at the Fall, 1981 meeting of the American Association for Cancer Education (AACE) were reviewed. These six terminal (general) and 40 enabling (specific) objectives were converted into 130 statements which were ranked from essential (rank 5) to not required (rank 0). The 58 pediatric oncology respondents gave broad support to the AACE pediatric oncology objectives. Primary importance was given to medical students knowing to refer pediatric malignancies. Principles of therapy, psychosocial management, management of infection, and complications during long term surveillance ranked high. Objectives were not ranked differently when related to number of new pediatric patients seen, type of hospital, or whether the institution had a core undergraduate pediatric training site. The list of terminal, enabling and supplemental pediatric oncology objectives developed by AACE appears valid for inclusion in the core curriculum of medical students.

Curriculum↗
PubMed2000

Nosocomial infections in pediatric patients: a European, multicenter prospective study. European Study Group.

OBJECTIVES: To determine the site and bacterial epidemiology of nosocomial infections (NIs) in children. DESIGN: 6-month prospective study with periodic chart review during hospitalization using a uniform prospective questionnaire in each unit, analyzed at a coordinating center. SETTING: 20 units in eight European countries: 5 pediatric intensive care units (PICUs), 7 neonatal units, 2 hematology-oncology units, 8 general pediatric units. PARTICIPANTS: All children hospitalized during the study period with an NI according to Centers for Disease Control and Prevention criteria. RESULTS: The overall incidence of NI was 2.5%, ranging from 1% in general pediatric units to 23.6% in PICUs. Bacteria were responsible for 68% (gram-negative bacilli, 37%; gram-positive cocci, 31%), Candida for 9%, and viruses for 22% of cases. The proportion of lower respiratory tract infections was 13% in general pediatric units and 53% in PICUs. Bloodstream infections were most frequent in neonatal units (71% of NIs) and were associated with a central venous catheter in 66% of cases. Coagulase-negative Staphylococcus (CNS) was the main pathogen. Eleven percent of NI were urinary tract infections. Gastrointestinal infections were most commonly viral and accounted for 76% of NIs in general pediatric units. The prevalence of antimicrobial resistance depended on the type of unit. The highest rates were observed in PICUs: 26.3% of Staphylococcus aureus and 89% of CNS were methicillin-resistant, and 37.5% of Klebsiella pneumoniae had an extended-spectrum beta-lactamase. Mortality due to NI was 10% in PICUs and 17% in neonatal units. CONCLUSIONS: We found large differences in NI frequency and microbial epidemiology in this European study. Viruses were the main pathogens in general pediatrics units. Catheter-related sepsis and CNS were frequent in newborns. A high frequency of multiresistant bacteria was observed in some units. Clinical monitoring of NIs and bacterial resistance profiles are required in all pediatric units.

Child↗
PubMed2003

Use of discharge abstract databases to differentiate among pediatric hospitals based on operative procedures: surgery in infants and young children in the state of Iowa.

INTRODUCTION: A pediatric hospital may aim to show governmental agencies, charitable organizations, and philanthropic individuals how its clinical services differ from those of nonpediatric surgical facilities and of other pediatric hospitals. Yet, it is unknown how to use existing databases to quantify where infants and young children undergo surgery, and to use that information to differentiate among facilities. METHODS: Discharge abstracts were used to study inpatient and outpatient operative procedures performed between January and June 2001 in children 0-2 yr old at hospitals or hospital-affiliated outpatient surgery centers in Iowa. RESULTS: Of the 93 facilities performing at least one procedure, the 90 performing 15 or fewer different types of procedures provided surgical care for 80% of procedures. Among procedures performed at these 90 facilities, less than 0.15% were physiologically complex (more than seven American Society of Anesthesiologists' basic units). In contrast, at the larger and smaller pediatric hospitals, the percentages were 26% and 7%, respectively. These pediatric hospitals performed 181 and 73 different types of procedures, respectively; 64% of the physiologically complex procedures performed statewide were performed at the larger pediatric hospital. The smaller pediatric hospital was no more similar to the larger pediatric hospital in its relative volumes of each type of procedure than it was to the other 91 facilities. CONCLUSIONS: Statewide discharge abstract data can be used by a hospital to quantify how its surgical practice differs from that of other hospitals (e.g., to show that it provides a more diverse, comprehensive, and physiologically complex selection of procedures in younger patients).

Adolescent↗
PubMed1994

Brain death in pediatric intensive care unit patients: incidence, primary diagnosis, and the clinical occurrence of Turner's triad.

OBJECTIVES: To determine the incidence and characteristics of children with brain death in the pediatric intensive care unit (ICU), and to assess the incidence of the clinical triad (Turner's triad) of central diabetes insipidus, low glucose demand, and low CO2 production. DESIGN: Retrospective review of medical records. SETTING: Two multidisciplinary pediatric ICUs. PATIENTS: Medical records of pediatric patients declared brain dead and admitted to two multidisciplinary pediatric ICUs. MEASUREMENTS AND MAIN RESULTS: Patient records were reviewed for demographic data, primary diagnosis, severity of illness (Pediatric Risk of Mortality score and calculated risk of mortality), methods by which brain-death diagnosis was determined, presence of central diabetes insipidus, low glucose demand, low CO2 production in the final 24 hrs before the diagnosis was made, and whether organ donation was accomplished. The incidence of brain death among all patients admitted to the pediatric ICUs was 0.9%, accounting for 11% of patients who died during the same period. The most common presentation leading to brain-death diagnoses was trauma, followed by drowning/near drowning, and meningitis. The majority of brain-death diagnoses were made using both clinical criteria and confirmatory tests (66%). The incidence of clinical signs of Turner's triad was 41% for central diabetes insipidus, 49% for low glucose demand, and 53% for low CO2 production. Two of the three features were present in 38% of patients, and 12% of the patients had all three features. CONCLUSIONS: Our series of brain-dead patients in the pediatric ICU showed a 0.9% incidence of brain death. The most common primary diagnosis was trauma, a finding that is similar to other series. We also demonstrated that the clinical triad (Turner's triad) is present in this patient population, although only 12% of study patients demonstrated all three features.

Adolescent↗
PubMed1996

Effects of availability of patient-related charges on practice patterns and cost containment in the pediatric intensive care unit.

OBJECTIVE: To investigate the effects of the availability of daily patient-related charges to healthcare providers on practice patterns and cost containment in the pediatric intensive care unit (ICU) setting. DESIGN: Prospective, nonrandomized, controlled trial. SETTING: Pediatric ICU. PATIENTS: All patients admitted to the pediatric ICU during the study period. This number included a prospective control group (n=325) and an intervention group (n=273). These 598 patients spent 2,274 patient days in the pediatric ICU. INTERVENTIONS: The daily itemized patient charges related to diagnostic studies ordered in the pediatric ICU were made available to healthcare providers during the intervention period of the study. MEASUREMENTS AND MAIN RESULTS: Information was collected prospectively on patients in the control group before the intervention period. This information included data on demographics, daily severity of illness measures, daily resource consumption, intensity of nursing and medical interventions, and daily patient-related charges. Outcome information on survival and length of pediatric ICU stay was also collected. The same data were collected prospectively during the intervention period of the study. Measurements on quality assurance and morbidity were made to ensure that there was no compromise in patient care. There were no significant differences in patient demographics and diagnoses between the control and intervention groups. There was a reduction in the average daily laboratory (16.7%), radiology (9.1%) computerized axial tomography (8.5%), and pharmacy (25.1%) charges in the intervention group as compared with controls. The decreases in laboratory and pharmacy charges were statistically significant (p<.0001). The decreases in laboratory and pharmacy charges remained significant even after adjustment for severity of illness. CONCLUSIONS: The availability of patient-related charges to healthcare providers can result in changes in practice patterns, producing a decrease of patient charges and an improvement in cost containment in the pediatric ICU.

Analysis of Variance↗
PubMed1999

Hospital costs of pediatric intensive care.

OBJECTIVE: To characterize hospital costs of pediatric intensive care and to determine which demographic and disease characteristics are associated with cost. DESIGN: Prospective cohort study. SETTING: A 20-bed pediatric intensive care unit (PICU) in an urban university-affiliated teaching children's hospital. PATIENTS: All children (n = 1,376) admitted to the multidisciplinary PICU during the fiscal year 1994. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographics, diagnoses, organ failure, Pediatric Risk of Mortality score, length of stay (LOS), and outcome were recorded. All hospital charges were obtained. The actual hospital costs were calculated by two separate methods. First, we converted the itemized patient charges into costs, using corresponding cost-to-charge ratios for each charge. In addition, we examined all direct and indirect expenses for the PICU. Univariate and multivariate regression analyses were used to determine the correlates to cost. The study population was similar to that of other studies of pediatric intensive care. The PICU was 86% efficient. The total cost for PICU care was $16,983,323. Average cost per admission was $12,342 +/- $22,313, and average cost per patient day was $2,264 +/- $868. The cost because of the PICU location (room cost) was 52.1% of all costs, and cost of laboratory studies was 18.3%. Respiratory therapy, pharmacy services, and radiology each accounted for between 6% and 8%. Total cost was most closely related to LOS, but severity of illness (Pediatric Risk of Mortality), diagnosis, and organ failure were also significant. Severity of illness was the most important factor in determining the variation in daily costs. Increased severity of illness was associated with higher laboratory and diagnostic study costs. We found little difference in the PICU room cost when calculated by adding direct and indirect expenses, compared with that obtained by using the cost-to-charge ratio. CONCLUSIONS: The maintenance of the specialty location and its personnel is the most costly component of pediatric intensive care. The strongest correlate with total cost for pediatric intensive care is LOS, but if costs are normalized for LOS, severity of illness best explains cost variation among patients. These data may serve as the basis for additional studies of resource allocation and consumption in the future.

Child↗
PubMed2000

Evaluating the frequency rate of hypomagnesemia in critically ill pediatric patients by using multiple regression analysis and a computer-based neural network.

OBJECTIVES: To determine the frequency rate of hypomagnesemia in patients admitted to the pediatric intensive care unit (ICU), and to identify subsets of patients (grouped by disease) who are at greatest risk of hypomagnesemia. We also compared a neural network model with multiple regression analysis to identify independent variables that would correlate with hypomagnesemia and to predict serum magnesium values in critically ill pediatric patients overall. DESIGN: Prospective, multicenter study. SETTING: Tertiary level medical/surgical pediatric ICUs. PATIENTS: Data were obtained at admission to the pediatric ICU for 463 patients from newborn to 18 yrs old who were admitted with a variety of surgical and nonsurgical conditions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Total serum magnesium values were obtained within the first 24 hrs after admission in 463 pediatric patients admitted to four pediatric ICUs. Hypomagnesemia (defined as total serum magnesium <0.75 mmol/L) was found in 51 (11%) of the 463 patients, with the highest frequency rate (72%) and lowest mean serum magnesium level (0.66 +/- 0.17 mmol/L) in patients admitted after surgery with extensive osseous involvement (spinal fusion and craniofacial reconstruction). To determine whether hypomagnesemia could be predicted on the basis of other laboratory and clinical criteria, multiple regression analysis was performed and showed age, weight, and albumin levels weakly associated (r2 = .14, p < .001) with magnesium levels within the different diagnostic groups. These data were used to produce a mathematical model able to predict magnesium levels within 5% of the actual values in 23% of patients. A neural network was also created to compare its predictive capabilities to those of the multiple regression model. Once trained on a random subset (85%) of the patient population, the neural network was able to predict magnesium levels to within 5% of actual values for 88% of the remaining 15% of patients, comparing favorably with the predictions derived from the multiple regression model. CONCLUSIONS: Hypomagnesemia is not uncommon (11%) in critically ill pediatric patients, but is very common (72%) in patients admitted after surgery for spinal fusion or craniofacial reconstruction. Patients who undergo surgery for correction of scoliosis and craniofacial anomalies should have serum magnesium levels monitored closely after surgery. In other patients, a neural network or multiple regression model could help predict which patients would be at risk of developing hypomagnesemia, thereby focusing testing on patients likely to benefit from such testing.

Adolescent↗
PubMed1992

Is a full team required for emergency management of pediatric trauma?

Pediatric trauma centers often do not meet the guidelines requiring a trauma team as recommended by the American Academy of Pediatrics (AAP). We reviewed our experience with a team consisting of a pediatric emergency physician, resident, nurse, and respiratory therapist. The surgical and pediatric critical care residents and staff were available within 5 minutes. We conducted a retrospective chart review of 146 patients (aged 8.1 +/- 4.8 years) between 1987 and 1989, with Injury Severity Scores (ISS) greater than or equal to 16 or admitted to the pediatric critical care unit. The time of presentation, surgical services consulted, and the nature of the injury were obtained from chart review. The Pediatric Trauma Score (PTS), the Revised Trauma Score (RTS), the Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, and Pediatric Risk of Mortality (PRISM) were used to determine the severity of insult and physiologic derangement on admission. The Modified Injury Severity Score (MISS) was determined and the Delta score for Disability Assessment was assigned at discharge. The Delta score was also determined at 3-month intervals up to one year. The probability of survival (Ps) was calculated, using the ISS and RTS. The Z statistic for this group of patients was then determined, using the Major Trauma Outcome Study (MTOS) methodology. The percentages of patients who were normal, disabled, and dead were 61%, 31.5%, and 7.5%, respectively, at 6 months follow-up. Eleven deaths were expected based on PRISM and TRISS analysis. Our mortality and morbidity figures were comparable with those of centers with teams based on AAP guidelines.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗