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At least 19 recordsLinked to original sources
PubMed1997

Nosocomial respiratory syncytial virus infection in Canadian pediatric hospitals: a Pediatric Investigators Collaborative Network on Infections in Canada Study.

OBJECTIVE: To determine nosocomial transmission of respiratory syncytial virus (RSV) in Canadian pediatric hospitals, outcomes associated with nosocomial disease, and infection control practices. DESIGN: A prospective cohort study in the 1992 to 1994 winter respiratory seasons. SETTING: Nine Canadian pediatric university-affiliated hospitals. PARTICIPANTS: Hospitalized children with symptoms of lower respiratory tract infection (at least one of cough, wheezing, dyspnea, tachypnea, and apnea) and RSV antigen identified in a nasopharyngeal aspirate. RESULTS: Of 1516 children, 91 (6%) had nosocomial RSV (NRSV), defined as symptoms of lower respiratory tract infection and RSV antigen beginning >72 hours after admission. The nosocomial ratio (NRSV/[com-munity-acquired RSV {CARSV})] + NRSV) varied by site from 2.8% to 13%. The median length of stay attributable to RSV for community-acquired illness was 5 days, but 10 days for nosocomial illness. Four children with NRSV (4. 4%) died within 2 weeks of infection, compared with 6 (0.42%) with CARSV (relative risk = 10.4, 95% confidence interval: 3.0, 36.4). All sites isolated RSV-positive patients in single rooms or cohorted them. In a multivariate model, no particular isolation policy was associated with decreased nosocomial ratio, but gowning to enter the room was associated with increased risk of RSV transmission (incidence rate ratio 2.81; confidence interval: 1.65, 4.77). CONCLUSIONS: RSV transmission risk in Canadian pediatric hospitals is generally low. Although use of barrier methods varies, all sites cohort or isolate RSV-positive patients in single rooms. Children with risk factors for severe disease who acquire infection nosocomially have prolonged stays and excess mortality.

Canada↗
PubMed2006

Epidemiologic surveillance of Clostridium difficile diarrhea in a freestanding pediatric hospital and a pediatric hospital at a university medical center.

To describe the epidemiology of Clostridium difficile in children, we cultured stool specimens from patients at the Children's Hospital Central California, Madera, CA (CHCC, n = 676) and at the University of California Davis Medical Center Pediatric Hospital, Sacramento, CA (UCDMC-PH, n = 301) for C. difficile, and toxins A and B genes and strain identity of the isolates were determined by polymerase chain reaction assays. A higher percentage of patients from UCDMC-PH were culture positive (148/301, 49%) and colonized with toxigenic strains (45/301, 15%) compared with CHCC (colonized = 178/676, 26%; toxigenic = 96/676, 14%, P < or = .001). Multiple logistic regression analysis showed decreased colonization with inpatient status (odds ratio [OR] = 0.64; 95% confidence interval [CI] = 0.46, 0.89; P = .007) and use of H-2 antagonists (OR = 0.55; 95% CI = 0.36, 0.84; P = .006), whereas underlying conditions (colonization: OR = 1.42; 95% CI = 1.02, 1.96; P = .04; toxin positive: OR = 1.60; 95% CI = 1.04, 2.44; P = .03) and exposure to > or =2 antiinfectives (colonization: OR = 1.56; 95% CI = 1.10, 2.20; P = .01; toxin positive: OR = 1.71; 95% CI = 1.10, 2.66; P = .02) increased colonization. Most isolates appear to be community acquired, although molecular analysis suggests some nosocomial transmission at UCDMC-PH. These data suggest that the epidemiology of colonization with C. difficile in children is different than previously reported.

Carrier State↗
PubMed2006

The value of the metabolic autopsy in the pediatric hospital setting.

OBJECTIVE: To determine the utility of the metabolic autopsy in the hospitalized pediatric patient. STUDY DESIGN: This was a retrospective review of all metabolic autopsies performed at a large pediatric hospital over a 5-year period. Premortem clinical diagnoses were correlated with autopsy findings and results of postmortem testing. RESULTS: Of the 23 metabolic autopsies performed, a metabolic disorder was diagnosed before death in 4 and after death by extensive studies initiated before death in 2. In the remaining 17 cases, postmortem samples were inadequate for subsequent enzymatic analysis in 2, a nonmetabolic explanation for symptoms was identified in 4, and no unifying diagnosis could be defined in 8. A metabolic disorder was diagnosed by postmortem tissue study in 3 of the 17 cases; in all 3 of these cases the patient died in the neonatal period after limited premortem investigation for primary lactic acidosis. For the 8 subjects who had undergone an extensive laboratory workup before death, in each case metabolic autopsy failed to establish a diagnosis. CONCLUSIONS: In a small but significant percentage of cases (18%), the metabolic autopsy successfully identified an undiagnosed metabolic disease. However, metabolic autopsy following an extensive nondiagnostic clinical workup is unlikely to yield a specific metabolic diagnosis.

Autopsy↗
PubMed2000

Ozone: a trigger for hospital pediatric asthma emergency room visits.

A time-series study was carried out in Paris from January 1 to December 31, 1988 with the aim of investigating the association between urban air pollution and daily emergency room visits for asthma in a pediatric hospital. Levels of black smoke, sulfur dioxide, nitrogen dioxide, and ozone were monitored throughout the study area, and meteorological data were collected. Influenza epidemics and pollen periods were identified. Health data were collected from a pediatric hospital emergency room. Case definition of asthma attacks was based on clinical diagnosis. Children were included in the study if: 1) they were 1 to 15 years old; 2) they had doctor-diagnosed asthma and were followed in our asthma outpatient clinic; and 3) they were residents in the Paris region. The relation between daily asthma visit counts and air pollution levels was assessed, using a multiple linear regression model and taking into account temporal variations and autocorrelation in the data. A thousand and twenty visits for asthma were observed during the study period. A positive statistical association was found between daily asthma visits and daily variations of ozone levels (1 day after exposure, relative risk = 1.52 [95% confidence interval: 1. 06-2.19]) after controlling for monthly and weekly variations, influenza epidemics, periods of pollen exposure, and daily mean temperature (2 days' lag). This study underlines the significant role of ozone as a trigger for asthma attacks in children.

Adolescent↗
PubMed1985

Current trends in Swiss hospital pediatrics (including pediatric surgery). Increasing importance of collaboration with child psychiatry.

The patients of a general pediatric hospital servicing a representative population are analyzed. 3% of the age group below 16 are admitted, whereof 2/3 as emergencies. The morbidity of boys is distinctly higher than for girls. 1/4 is less than 2 years old. Hospitalization rate for infants is much higher than for older age groups. Surgery slowly outnumbers medicine for inpatients. The most frequent single diagnoses are surgical ones, whereas in medicine diagnoses are scattered over a much broader spectrum. Over 11% of all patients had social, psychosomatic or psychological conflicts significantly contributing to the symptomatology presented, for medicine alone it was one out of five patients! Paternal profession, social failures and family quarrels are important for this cohort. A setting of child psychiatry on a consultant basis should complement the traditional framework of pediatric medicine and surgery; hospital pediatrics can then best offer the necessary structures. The pediatrician's role has to remain central, but additional training is mandatory.

Adolescent↗
PubMedDate not supplied

Pediatric hospital dying trajectories: what we learned and can share.

Diverse settings, diagnoses, and time constraints challenge a small hospital's ability to provide comprehensive care to all dying children and their families. Children who died at a regional hospital in southeast Georgia were studied to document the circumstances under which they died and the palliative and end-of-life care provided. The most common causes of death were injury and circulatory events. At the time of death, 56% of the children studied were in the care of the Emergency Department. Seventy-two percent were previously healthy children; 78% were hospitalized for less than 24 hours prior to death. Based on previous medical history and length of final hospitalization, four hospital dying trajectories were defined. Hospital dying trajectories provide a basis for planning comprehensive hospital pediatric palliative and end-of-life care program by identifying the settings, time limitations, and key personnel.

Adolescent↗
PubMedDate not supplied

Pain in hospitalized pediatric patients: how are we doing?

OBJECTIVE: The purpose of this study was to provide a baseline description of the prevalence of pain and pain management strategies in a pediatric hospital and to compare the prevalence of pain in this hospital to that in published reports in the literature. METHODS: Two hundred thirty-seven children ranging in age from 10 days to 17 years and 223 parents participated in an 8-hour survey on 5 inpatient units. Information about pain intensity and pain affect was collected from the children older than 6 years of age and from parents of those who were younger at 4 2-hour intervals. Information about procedural pain was collected from children, parents, and health care professionals over this 8-hour period. The type and amount of analgesia were also noted. RESULTS: More than 20% of the children had clinically significant pain at each of the 2-hour intervals, and 7 had pain scores of 5/10 or greater for the majority of the study day. At least 50% of the children were found to be pain-free during the 4 intervals, and there was a high level of agreement between parents and children's pain-intensity ratings. One hundred fifty-seven children had medication ordered and 80 children had no analgesia ordered. There was no significant correlation between characteristics of the patients and amounts or types of medication given. No analgesia was administered via intramuscular or subcutaneous injection. DISCUSSION: Although these results are encouraging in that a significant portion of the children were pain-free during the study day, the number of children who had clinically significant pain was too high. The results of this study compare with others in that a significant number of children were inadequately treated for pain. Clinical implications are discussed.

Adolescent↗
PubMed1992

[The degree of agreement of the clinical and the histopathological diagnoses in a tertiary medical care pediatric hospital].

In Pediatric Hospital, from the National Medical Center, of the Mexican Institute of Social Security were analyzed 96 histological pieces: 59 biopsies, 21 surgical material and 16 slides. There were showed the agreement rate between clinical diagnosis and the end histopathological report from the Pathology Department. The higher correlation rate were with biopsies (83%) and surgical material (81%) and the lowest rate were with slides samples (69%). There were not statistical difference in the 3 study groups (P greater than 0.05). The overall concordance with the clinical diagnosis were 82%. The overall concordance with the 3 study groups were 80%. It is concluded what agreement rate was satisfactory in biopsies and surgical material and the agreement rate measure is an actual parameter in evaluation of clinical competence and also in the evaluation of medical care quality.

Biopsy↗
PubMed1998

Comparison of pediatric hospitalization using the pediatric appropriateness evaluation protocol at three diverse hospitals in Louisiana.

The purpose of this study was to compare the number of inappropriate pediatric admissions and hospital days in three hospitals in Louisiana using Pediatric Appropriateness Evaluation Protocol (PAEP) criteria. The hospitals studied included an urban, nontertiary care, teaching hospital with 20 inpatient, pediatric beds (A); a private, tertiary care hospital with 30 beds (B); and a tertiary care, regional referral center with 133 pediatric beds (C). The study prospectively observed all nonintensive care pediatric admissions (> six months of age) between May 1 and June 30, 1993. Admissions and subsequent hospital days were labeled as appropriate or inappropriate based on PAEP criteria. A significantly shorter hospital stay (days) was demonstrated at hospital C (4.41 +/- 1.01, p < .05) compared to A (5.98 +/- 4.95) or B (5.78 +/- 1.21). Similarly, hospital B had significantly more patients admitted electively (19%, p < .05) compared to A (4%) or C (15%). The percentage of inappropriate admissions for hospitals A, B, and C were 11.0, 10.0, and 2.0 (p < .05) and hospital days 18.0, 22.0, and 12.0 (p < .05), respectively. A significant proportion of inappropriate hospital days came from trauma admissions in hospital A (18%, p < .05) and elective admissions in hospital B (36%, p < .05). Hospital A had 99% of patients with either Medicaid or uninsured payor status compared to 35% and 84% at hospital B and C, respectively. Significant differences in the rate of inappropriate admission or subsequent hospital days were demonstrated in the three hospitals studied. Finally, the rates of inappropriate hospitalization demonstrated in this study of Louisiana hospitals were similar to previous studies using the PAEP in other regions.

Analysis of Variance↗
PubMed2005

Pain management for the hospitalized pediatric patient.

Pediatric hospitalists should make pain assessment and treatment a high priority and a central part of their daily practice. Efforts at improving pain treatment in pediatric hospitals should be multidisciplinary and should involve combined use of pharmacologic and nonpharmacologic approaches. Although available information can permit effective treatment of pain for most children in hospitals, there is a need for more research on pediatric analgesic pharmacology, various nonpharmacologic treatments, and different models of delivery of care.

Analgesia↗
PubMed2003

Refeeding syndrome in hospitalized pediatric patients.

Refeeding syndrome has been well documented over the years, primarily through case reports and literature reviews. Awareness of refeeding syndrome is crucial in preventing the occurrence of, and the metabolic and physiologic complications associated with, aggressive nutrition support in malnourished populations. Once compromised patients have been identified to be at risk of refeeding syndrome, nutrition rehabilitation should be cautiously initiated. We have found a lack of clinical validation for instituting nutrition support in high-risk pediatric patients who may develop refeeding syndrome. The purposes of our investigation were to determine the incidence of refeeding syndrome in pediatric hospitalized patients beginning on parenteral nutrition and to determine how consistently the Department of Clinical Nutrition standards of care for screening and prevention were followed at our institution.

Journal Article↗
PubMed1990

[The demand for emergency services at pediatric hospitals: a study of 4,858 cases treated at the emergency department of a pediatric hospital].

Given the rise in hospital emergencies, a detailed study of the demand for emergency pediatric care is a must. We compiled 4,858 medical records elected at random and gathered data about global activity in the emergency department of pediatric hospital. The demand for emergency pediatric care grows faster than the corresponding population. The higher and lower patient influxes were on Sunday and Wednesday respectively. The peak rate of influx was attained at 8 pm, whereas the low happened at 6 am. Pediatric emergencies diminish with age and are less frequent in girls than in boys. Only 15.86% of the patients had been referred by a physician. Fever and accidents were the most frequent reason for consultation. Ear, nose and throat diseases are at the top and double in frequency the bronchopulmonary sickness. Analyses were done in 12% of the cases, radiographs were taken in 23% of the patients and 68.58% of the casualties were taken were care of without any of these means. The visit was finished in a mean of 1.99 hours, a swift performance. Of all the cases studied, 93.4% were discharged and 5.3% were admitted to the same hospital. Our data confirm and complete the one published fragmentarily in the Spanish literature. We emphasize that a primary pediatrician could have spared the emergency department a lot of work. We conclude that accessible continuous care must be offered in order to transcend patchwork in following growth and development through pediatric emergency rooms.

Child↗