13 results on '"Aronson PL"'
Search Results
2. Contaminant Organism Growth in Febrile Infants at Low Risk for Invasive Bacterial Infection.
- Author
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Singh NV, Gutman CK, Green RS, Thompson AD, Jackson K, Kalari NC, Lucrezia S, Krack A, Corboy JB, Cheng T, Duong M, St Pierre-Hetz R, Akinsola B, Kelly J, Sartori LF, Yan X, Lou XY, Lion KC, Fernandez R, and Aronson PL
- Subjects
- Infant, Humans, Cross-Sectional Studies, Retrospective Studies, Fever complications, Urinalysis, Bacterial Infections complications
- Abstract
In this multicenter, cross-sectional, secondary analysis of 4042 low-risk febrile infants, nearly 10% had a contaminated culture obtained during their evaluation (4.9% of blood cultures, 5.0% of urine cultures, and 1.8% of cerebrospinal fluid cultures). Our findings have important implications for improving sterile technique and reducing unnecessary cultures., Competing Interests: Declaration of Competing Interest Colleen K. Gutman was supported by NIH/NCATS grant number KL2TR001429. Paul L. Aronson is supported by NIH/NICHD grant number R03 HD110741. The NIH had no role in the design and conduct of the study. The other authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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3. Association of Clinical Guidelines and Decision Support with Computed Tomography Use in Pediatric Mild Traumatic Brain Injury.
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Marin JR, Rodean J, Mannix RC, Hall M, Alpern ER, Aronson PL, Chaudhari PP, Cohen E, Freedman SB, Morse RB, Peltz A, Samuels-Kalow M, Shah SS, Simon HK, and Neuman MI
- Subjects
- Adolescent, Brain Concussion epidemiology, Child, Child, Preschool, Cross-Sectional Studies, Databases, Factual, Emergency Service, Hospital organization & administration, Emergency Service, Hospital statistics & numerical data, Female, Humans, Infant, Infant, Newborn, Length of Stay, Male, Surveys and Questionnaires, Brain Concussion diagnostic imaging, Decision Support Systems, Clinical, Practice Guidelines as Topic, Tomography, X-Ray Computed statistics & numerical data
- Abstract
Objective: To examine whether the presence of clinical guidelines and clinical decision support (CDS) for mild traumatic brain injury (mTBI) are associated with lower use of head computed tomography (CT)., Study Design: We conducted a cross-sectional study of 45 pediatric emergency departments (EDs) in the Pediatric Hospital Information System from 2015 through 2019. We included children discharged with mTBI and surveyed ED clinical directors to ascertain the presence and implementation year of clinical guidelines and CDS. The association of clinical guidelines and CDS with CT use was assessed, adjusting for relevant confounders. As secondary outcomes, we evaluated ED length of stay and rates of 3-day ED revisits and admissions after revisits., Results: There were 216 789 children discharged with mTBI, and CT was performed during 20.3% (44 114/216 789) of ED visits. Adjusted hospital-specific CT rates ranged from 11.8% to 34.7% (median 20.5%, IQR 17.3%, 24.3%). Of the 45 EDs, 17 (37.8%) had a clinical guideline, 9 (20.0%) had CDS, and 19 (42.2%) had neither. Compared with EDs with neither a clinical guideline nor CDS, visits to EDs with CDS (aOR 0.52 [0.47, 0.58]) or a clinical guideline (aOR 0.83 [0.78, 0.89]) had lower odds of including a CT for mTBI. ED length of stay and revisit rates did not differ based on the presence of a clinical guideline or CDS., Conclusions: Clinical guidelines for mTBI, and particularly CDS, were associated with lower rates of head CT use without adverse clinical outcomes., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
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4. Outcomes of Young Infants with Hypothermia Evaluated in the Emergency Department.
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Ramgopal S, Noorbakhsh KA, Pruitt CM, Aronson PL, Alpern ER, and Hickey RW
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- Bacteremia epidemiology, Chronic Disease epidemiology, Cohort Studies, Cross-Sectional Studies, Female, Herpes Simplex epidemiology, Hospital Mortality, Humans, Infant, Infant, Newborn, Length of Stay statistics & numerical data, Male, Meningitis, Bacterial epidemiology, Patient Admission statistics & numerical data, Pneumonia epidemiology, Pregnancy, Pregnancy Complications, Infectious epidemiology, Retrospective Studies, United States epidemiology, Urinary Tract Infections epidemiology, Emergency Service, Hospital, Hypothermia epidemiology
- Abstract
Objective: To assess the prevalence of serious infections and mortality among infants ≤90 days of age presenting to the emergency department with hypothermia., Study Design: We performed a cross-sectional cohort study of infants ≤90 days presenting to any of 40 EDs in the Pediatric Health Information Systems between January 1, 2009, and December 31, 2018. Infants with an International Classification of Diseases, ninth or tenth edition, admission/discharge diagnosis code of hypothermia were included. We determined the prevalence of serious bacterial infection (urinary tract infection, bacteremia, and/or bacterial meningitis), pneumonia, herpes simplex virus (HSV) infection, and emergency department/hospital mortality., Results: We included 3565 infants (1633 male [50.9%] and 3225 ≤30 days of age [90.5%]). Most (65.0%) presented in the first week of life. There were 389 infants (10.8%) with a complex chronic condition. The prevalence of serious bacterial infection was 8.0% (n = 284), including 2.4% (n = 87) with urinary tract infection, 5.6% (n = 199) with bacteremia, and 0.3% (n = 11) with bacterial meningitis. There were 7 patients (0.2%) with neonatal HSV and 9 (0.3%) with pneumonia; 0.2% (n = 6) died. The presence of a complex chronic condition was associated with the presence of serious bacterial infection (P < .001) and was present in 3 of 6 patients who died. In a sensitivity analysis including patients with any diagnosis code of hypothermia (n = 8122), 14.9% had serious bacterial infection, 0.6% had HSV, and 3.3% had pneumonia; 2.0% died., Conclusions: Of infants with hypothermia ≤90 days of age, 8.3% had serious bacterial infections or HSV. Compared with literature from febrile infants, hypothermia is associated with a high mortality rate. Complex chronic conditions were particularly associated with poor outcomes. Additional research is required to risk stratify young infants with hypothermia., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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5. Routine CSF analysis may not be indicated in febrile infants with a positive urinalysis.
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Aronson PL
- Subjects
- Fever, Humans, Infant, Urinalysis, Meningitis, Urinary Tract Infections
- Published
- 2020
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6. Factors Associated with Adverse Outcomes among Febrile Young Infants with Invasive Bacterial Infections.
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Pruitt CM, Neuman MI, Shah SS, Shabanova V, Woll C, Wang ME, Alpern ER, Williams DJ, Sartori L, Desai S, Leazer RC, Marble RD, McCulloh RJ, DePorre AG, Rooholamini SN, Lumb CE, Balamuth F, Shin S, and Aronson PL
- Subjects
- Anti-Bacterial Agents administration & dosage, Bacteremia mortality, Cohort Studies, Female, Fever mortality, Humans, Infant, Infant Mortality, Infant, Newborn, Male, Meningitis, Bacterial mortality, Retrospective Studies, Risk Factors, Bacteremia complications, Fever complications, Meningitis, Bacterial complications
- Abstract
Objective: To determine factors associated with adverse outcomes among febrile young infants with invasive bacterial infections (IBIs) (ie, bacteremia and/or bacterial meningitis)., Study Design: Multicenter, retrospective cohort study (July 2011-June 2016) of febrile infants ≤60 days of age with pathogenic bacterial growth in blood and/or cerebrospinal fluid. Subjects were identified by query of local microbiology laboratory and/or electronic medical record systems, and clinical data were extracted by medical record review. Mixed-effect logistic regression was employed to determine clinical factors associated with 30-day adverse outcomes, which were defined as death, neurologic sequelae, mechanical ventilation, or vasoactive medication receipt., Results: Three hundred fifty infants met inclusion criteria; 279 (79.7%) with bacteremia without meningitis and 71 (20.3%) with bacterial meningitis. Forty-two (12.0%) infants had a 30-day adverse outcome: 29 of 71 (40.8%) with bacterial meningitis vs 13 of 279 (4.7%) with bacteremia without meningitis (36.2% difference, 95% CI 25.1%-48.0%; P < .001). On adjusted analysis, bacterial meningitis (aOR 16.3, 95% CI 6.5-41.0; P < .001), prematurity (aOR 7.1, 95% CI 2.6-19.7; P < .001), and ill appearance (aOR 3.8, 95% CI 1.6-9.1; P = .002) were associated with adverse outcomes. Among infants who were born at term, not ill appearing, and had bacteremia without meningitis, only 2 of 184 (1.1%) had adverse outcomes, and there were no deaths., Conclusions: Among febrile infants ≤60 days old with IBI, prematurity, ill appearance, and bacterial meningitis (vs bacteremia without meningitis) were associated with adverse outcomes. These factors can inform clinical decision-making for febrile young infants with IBI., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2019
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7. Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments.
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Woll C, Neuman MI, Pruitt CM, Wang ME, Shapiro ED, Shah SS, McCulloh RJ, Nigrovic LE, Desai S, DePorre AG, Leazer RC, Marble RD, Balamuth F, Feldman EA, Sartori LF, Browning WL, and Aronson PL
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- Bacterial Infections drug therapy, Bacterial Infections microbiology, Cross-Sectional Studies, Female, Humans, Incidence, Infant, Infant, Newborn, Male, Retrospective Studies, United States epidemiology, Anti-Bacterial Agents therapeutic use, Bacteria isolation & purification, Bacterial Infections epidemiology, Emergency Service, Hospital
- Abstract
Objectives: To help guide empiric treatment of infants ≤60 days old with suspected invasive bacterial infection by describing pathogens and their antimicrobial susceptibilities., Study Design: Cross-sectional study of infants ≤60 days old with invasive bacterial infection (bacteremia and/or bacterial meningitis) evaluated in the emergency departments of 11 children's hospitals between July 1, 2011 and June 30, 2016. Each site's microbiology laboratory database or electronic medical record system was queried to identify infants from whom a bacterial pathogen was isolated from either blood or cerebrospinal fluid. Medical records of these infants were reviewed to confirm the presence of a pathogen and to obtain demographic, clinical, and laboratory data., Results: Of the 442 infants with invasive bacterial infection, 353 (79.9%) had bacteremia without meningitis, 64 (14.5%) had bacterial meningitis with bacteremia, and 25 (5.7%) had bacterial meningitis without bacteremia. The peak number of cases of invasive bacterial infection occurred in the second week of life; 364 (82.4%) infants were febrile. Group B streptococcus was the most common pathogen identified (36.7%), followed by Escherichia coli (30.8%), Staphylococcus aureus (9.7%), and Enterococcus spp (6.6%). Overall, 96.8% of pathogens were susceptible to ampicillin plus a third-generation cephalosporin, 96.0% to ampicillin plus gentamicin, and 89.2% to third-generation cephalosporins alone., Conclusions: For most infants ≤60 days old evaluated in a pediatric emergency department for suspected invasive bacterial infection, the combination of ampicillin plus either gentamicin or a third-generation cephalosporin is an appropriate empiric antimicrobial treatment regimen. Of the pathogens isolated from infants with invasive bacterial infection, 11% were resistant to third-generation cephalosporins alone., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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8. Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger.
- Author
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Aronson PL, Lyons TW, Cruz AT, Freedman SB, Okada PJ, Fleming AH, Arms JL, Thompson AD, Schmidt SM, Louie J, Alfonzo MJ, Monuteaux MC, and Nigrovic LE
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- Cohort Studies, Female, Humans, Infant, Male, Retrospective Studies, Cerebrospinal Fluid virology, Enterovirus genetics, Enterovirus Infections diagnosis, Length of Stay statistics & numerical data, Meningitis, Viral diagnosis, Polymerase Chain Reaction methods
- Abstract
Objective: To determine the impact of a cerebrospinal fluid enterovirus polymerase chain reaction (PCR) test performance on hospital length of stay (LOS) in a large multicenter cohort of infants undergoing evaluation for central nervous system infection., Study Design: We performed a planned secondary analysis of a retrospective cohort of hospitalized infants ≤60 days of age who had a cerebrospinal fluid culture obtained at 1 of 18 participating centers (2005-2013). After adjustment for patient age and study year as well as clustering by hospital center, we compared LOS for infants who had an enterovirus PCR test performed vs not performed and among those tested, for infants with a positive vs negative test result., Results: Of 19 953 hospitalized infants, 4444 (22.3%) had an enterovirus PCR test performed and 945 (21.3% of tested infants) had positive test results. Hospital LOS was similar for infants who had an enterovirus PCR test performed compared with infants who did not (incident rate ratio 0.98 hours; 95% CI 0.89-1.06). However, infants PCR positive for enterovirus had a 38% shorter LOS than infants PCR negative for enterovirus (incident rate ratio 0.62 hours; 95% CI 0.57-0.68). No infant with a positive enterovirus PCR test had bacterial meningitis (0%; 95% CI 0-0.4)., Conclusions: Although enterovirus PCR testing was not associated with a reduction in LOS, infants with a positive enterovirus PCR test had a one-third shorter LOS compared with infants with a negative enterovirus PCR test. Focused enterovirus PCR test use could increase the impact on LOS for infants undergoing cerebrospinal fluid evaluation., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
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9. Delayed Diagnoses in Children with Constipation: Multicenter Retrospective Cohort Study.
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Freedman SB, Rodean J, Hall M, Alpern ER, Aronson PL, Simon HK, Shah SS, Marin JR, Cohen E, Morse RB, Katsogridakis Y, Berry JG, and Neuman MI
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- Adolescent, Age Factors, Child, Female, Humans, Male, Patient Readmission, Retrospective Studies, Risk Factors, Constipation diagnostic imaging, Constipation etiology, Delayed Diagnosis, Emergency Service, Hospital, Radiography, Abdominal
- Abstract
Objective: The use of abdominal radiographs contributes to increased healthcare costs, radiation exposure, and potentially to misdiagnoses. We evaluated the association between abdominal radiograph performance and emergency department (ED) revisits with important alternate diagnosis among children with constipation., Study Design: Retrospective cohort study of children aged <18 years diagnosed with constipation at one of 23 EDs from 2004 to 2015. The primary exposure was abdominal radiograph performance. The primary outcome was a 3-day ED revisit with a clinically important alternate diagnosis. RAND/University of California, Los Angeles methodology was used to define whether the revisit was related to the index visit and due to a clinically important condition other than constipation. Regression analysis was performed to identify exposures independently related to the primary outcome., Results: A total of 65.7% (185 439/282 225) of children with constipation had an index ED visit abdominal radiograph performed. Three-day revisits occurred in 3.7% (10 566/282 225) of children, and 0.28% (784/282 225) returned with a clinically important alternate related diagnosis. Appendicitis was the most common such revisit, accounting for 34.1% of all 3-day clinically important related revisits. Children who had an abdominal radiograph performed were more likely to have a 3-day revisit with a clinically important alternate related diagnosis (0.33% vs 0.17%; difference 0.17%; 95% CI 0.13-0.20). Following adjustment for covariates, abdominal radiograph performance was associated with a 3-day revisit with a clinically important alternate diagnosis (aOR: 1.39; 95% CI 1.15-1.67). Additional characteristics associated with the primary outcome included narcotic (aOR: 2.63) and antiemetic (aOR: 2.35) administration and underlying comorbidities (aOR: 2.52)., Conclusions: Among children diagnosed with constipation, abdominal radiograph performance is associated with an increased risk of a revisit with a clinically important alternate related diagnosis., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
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10. Impact of Chronic Conditions on Emergency Department Visits of Children Using Medicaid.
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Berry JG, Rodean J, Hall M, Alpern ER, Aronson PL, Freedman SB, Brousseau DC, Shah SS, Simon HK, Cohen E, Marin JR, Morse RB, O'Neill M, and Neuman MI
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- Adolescent, Child, Child, Preschool, Chronic Disease epidemiology, Cohort Studies, Databases, Factual, Female, Health Care Costs, Health Services Research, Hospitalization economics, Hospitalization statistics & numerical data, Humans, Infant, Length of Stay economics, Male, Medicaid economics, Retrospective Studies, Risk Assessment, United States, Chronic Disease therapy, Emergency Service, Hospital statistics & numerical data, Medicaid statistics & numerical data, Outcome Assessment, Health Care
- Abstract
Objective: To assess the impact of chronic conditions on children's emergency department (ED) use., Study Design: Retrospective analysis of 1 850 027 ED visits in 2010 by 3 250 383 children ages 1-21 years continuously enrolled in Medicaid from 10 states included in the Truven Marketscan Medicaid Database. The main outcome was the annual ED visit rate not resulting in hospitalization per 1000 enrollees. We compared rates by enrollees' characteristics, including type and number of chronic conditions, and medical technology (eg, gastrostomy, tracheostomy), using Poisson regression. To assess chronic conditions, we used the Agency for Healthcare Research and Quality's Chronic Condition Indicator system, assigning chronic conditions with ED visit rates ≥75th percentile as having the "highest" visit rates., Results: The overall annual ED visit rate was 569 per 1000 enrollees. As the number of the children's chronic conditions increased from 0 to ≥3, visit rates increased by 180% (from 376 to 1053 per 1000 enrollees, P < .001). Rates were 174% higher in children assisted with vs without medical technology (1546 vs 565, P < .001). Sickle cell anemia, epilepsy, and asthma were among the chronic conditions associated with the highest ED visit rates (all ≥1003 per 1000 enrollees)., Conclusions: The highest ED visit rates resulting in discharge to home occurred in children with multiple chronic conditions, technology assistance, and specific conditions such as sickle cell anemia. Future studies should assess the preventability of ED visits in these populations and identify opportunities for reducing their ED use., (Copyright © 2016. Published by Elsevier Inc.)
- Published
- 2017
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11. Reply.
- Author
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Florin TA, Aronson PL, and Neuman MI
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- Female, Humans, Male, Cerebrospinal Fluid Shunts methods, Emergency Service, Hospital statistics & numerical data, Hydrocephalus surgery, Tomography, X-Ray Computed statistics & numerical data
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- 2016
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12. Association between Clinical Outcomes and Hospital Guidelines for Cerebrospinal Fluid Testing in Febrile Infants Aged 29-56 Days.
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Chua KP, Neuman MI, McWilliams JM, and Aronson PL
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- Female, Fever cerebrospinal fluid, Fever etiology, Humans, Infant, Infant, Newborn, Male, Meningitis, Bacterial cerebrospinal fluid, Retrospective Studies, United States, Cerebrospinal Fluid chemistry, Emergency Service, Hospital, Fever diagnosis, Hospitals, Pediatric, Meningitis, Bacterial complications, Practice Guidelines as Topic
- Abstract
Objective: To describe the association between clinical outcomes and clinical practice guidelines (CPGs) recommending universal cerebrospinal fluid (CSF) testing in the emergency department for febrile infants aged 29-56 days., Study Design: Using 2007-2013 administrative data from 32 US children's hospitals, we performed a difference-in-differences analysis comparing 7 hospitals with CPGs recommending universal CSF testing for older febrile infants aged 29-56 days (CPG group) with 25 hospitals without such CPGs (control group). We compared differences in clinical outcomes between older febrile infants with the corresponding differences among younger febrile infants aged 7-28 days. The primary outcome was the occurrence of an adverse event, defined as a delayed diagnosis of bacterial meningitis, mechanical ventilation, placement of a central venous catheter, extracorporeal membrane oxygenation, or in-hospital mortality. Analyses were adjusted for race/ethnicity, sex, median annual household income by zip code, primary insurance source, discharge season, and discharge year., Results: The proportion of older febrile infants undergoing CSF testing was higher (P < .001) in the CPG group (64.8%) than the control group (47.8%). CPGs recommending universal CSF testing for older febrile infants were not associated with significant differences in adverse events (difference-in-differences: +0.31 percentage points, 95% CI -0.18 to 0.85; P = .22)., Conclusions: Hospital CPGs recommending universal CSF testing for febrile infants aged 29-56 days were not associated with significant differences in clinical outcomes., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
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13. Emergency Department Use of Computed Tomography for Children with Ventricular Shunts.
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Florin TA, Aronson PL, Hall M, Kharbanda AB, Shah SS, Freedman SB, Alpern ER, Mistry RD, Simon HK, Berry J, Coley BD, and Neuman MI
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- Adolescent, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Hydrocephalus diagnostic imaging, Infant, Infant, Newborn, Male, Retrospective Studies, Cerebrospinal Fluid Shunts methods, Emergency Service, Hospital statistics & numerical data, Hydrocephalus surgery, Tomography, X-Ray Computed statistics & numerical data
- Abstract
Objectives: To quantify rates and variation in emergency department (ED) cranial computed tomography (CT) utilization in children with ventricular shunts, estimate radiation exposure, and evaluate the association between CT utilization and shunt revision., Study Design: Retrospective longitudinal cohort study of ED visits from 2003-2013 in children 0-18 years old with initial shunt placement in 2003. Data were examined from 31 hospitals in the Pediatric Health Information System. Main outcomes were cranial CT performed during an ED visit, estimated cumulative effective radiation dose, and shunt revision within 7 days. Multivariable regression modeled the relationship between patient- and hospital-level covariates and CT utilization., Results: The 1319 children with initial shunt placed in 2003 experienced 6636 ED visits during the subsequent decade. A cranial CT was obtained in 49.4% of all ED visits; 19.9% of ED visits with CT were associated with a shunt revision. Approximately 6% of patients received ≥10 CTs, accounting for 37.2% of all ED visits with a CT. The mean number of CTs per patient varied nearly 20-fold across hospitals; the individual hospital accounted for the most variation in CT utilization. The median (IQR) cumulative effective radiation dose was 7.2 millisieverts (3.6-14.0) overall, and 33.4 millisieverts (27.2-43.8) among patients receiving ≥10 CTs., Conclusions: A CT scan was obtained in half of ED visits for children with a ventricular shunt, with wide variability in utilization by hospitals. Strategies are needed to identify children at risk of shunt malfunction to reduce variability in CT utilization and radiation exposure in the ED., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
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