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Abstract Background Reported incidence of blood transfusion reactions (TR) varies greatly. Objective To prospectively evaluate the incidence of acute TRs in dogs receiving allogenic blood products, using consensus definitions, and to assess factors associated with TRs. Animals Dogs (n = 858) administered allogenic blood products (n = 1542) between March and November 2022. Methods Prospective, multicenter surveillance study occurring in referral hospitals in the United States, United Kingdom, and Australia recording TRs in dogs administered blood products as defined by the consensus guidelines published by The Association of Veterinary Hematology and Transfusion Medicine in 2021. Results The incidence of acute TR was 8.9% (95% CI 7.0‐11.1) for packed red blood cells (pRBCs) and 4.5% (95% CI 2.9‐6.6) for plasma products. The most frequently reported TRs were febrile nonhemolytic TRs (FNHTR; 4%, 95% CI 2.8‐5.5) when administering pRBCs and allergic TRs (3.2%, 95% CI 1.80‐5.10) when administering plasma products. A higher dose of pRBC (adjusted odds ratio [aOR] 1.04 [95% CI 1.00‐1.08]) was associated with a higher odds of TR. Administration of pRBCs stored for longer than 28 days was associated with higher odds of FNHTR (aOR 4.10 [95% CI 1.58‐10.65]) and acute hemolytic TR (AHTR; OR 15.2 [95% CI 3.35‐68.70]) when compared with pRBCs stored for 14 days or fewer. Leukoreduction of pRBC was not associated with lower odds of developing a TR (OR 1.47 [95% CI 0.89‐2.42]). Conclusions and Clinical Importance Clinicians should be mindful of the age and dose of pRBC prescribed to dogs.

Case summary A 6-month-old female entire domestic shorthair cat was presented with a 4-day history of progressive swelling over the dorsal cranium. Subsequent diagnostics revealed a large haematoma, a secondary haemostatic defect and a moderate anaemia. The owner disclosed access to multiple brodifacoum bait stations. The anaemia and haematoma progressed despite treatment with fresh frozen plasma and phytonadione and the cat developed signs of haemorrhagic shock. Allogenic transfusion was declined due to cost and 18 ml of blood was aspirated from the haematoma and transfused. The cat stabilised quickly and was discharged the next day with oral phytonadione. Relevance and novel information Autologous transfusion from the subcutaneous space has not been previously reported. It was well tolerated and life-saving in this case.

Abstract Objectives To characterize trends in pediatric mental health visit counts, including visits for prolonged length of stay (LOS), in a sample of emergency departments (EDs) from 29 states during COVID‐19. Methods We performed a secondary analysis of the Clinical Emergency Data Registry from January 2020 through December 2021. We reported trends in pediatric mental health visit counts overall and for those with prolonged ED LOS. We reported incident rate ratios (IRRs) for monthly counts compared to January 2020. Among visits with LOS >24 hours, we reported on the most common diagnostic categories. Results There were 107 EDs from 29 states with available complete data in 2020 and 2021. Pediatric mental health visit counts resulting in a LOS greater than 6, 12, and 24 hours were higher for much of 2021. At their peak, there were 604 visits with LOS >12 hours (IRR, 2.14; 95% confidence interval [CI], 1.86–2.47) and 262 visits (IRR, 2.46; 95% CI, 1.97–3.09) with LOS >24 hours in April 2021. Pediatric mental health visits with LOS >12 hours and >24 hours made up 20.9% and 7.3% of pediatric mental health visits overall, respectively. For visits with ED LOS >24 hours, the most common diagnostic categories were suicide or self‐injury, depressive disorders, and mental health syndrome. Conclusions In this sample of 107 EDs in 29 states, visit counts with prolonged LOS >24 hours more than doubled in some months since the arrival of COVID‐19. These findings are indicative of an increasingly strained emergency and mental health system.

The emergence of the Omicron variant was accompanied by an acute increase in COVID-19 cases and hospitalizations in New York City. An increased incidence of COVID-19-associated croup in children during the Omicron wave has been recognized, suggesting that there may be other changes in clinical symptoms and severity. To better understand clinical outcomes and health care utilization in children infected with SARS-CoV-2 during the Omicron wave, we performed a cross-sectional study in pediatric patients aged ≤18 years who were tested for SARS-CoV-2 in pediatric emergency departments within a large medical system in New York City from 2 December 2021 to 23 January 2022. We described the clinical characteristics and outcomes of pediatric patients who presented to the pediatric emergency department and were hospitalized with SARS-CoV-2 infection during the Omicron wave in New York City. There were 2515 children tested in the ED for SARS-CoV-2 of whom 794 (31.6%) tested positive. Fifty-eight children were hospitalized for a COVID-19-related indication, representing 7.3% of all COVID-19-positive children and 72% of hospitalized COVID-19-positive children. Most (64%) children hospitalized for a COVID-19-related indication were less than 5 years old. Indications for hospitalization included respiratory symptoms, clinical monitoring of patients with comorbid conditions, and exacerbations of underlying disease. Eleven (19%) hospitalized children were admitted to the ICU and six (10%) required mechanical ventilation. Children infected with COVID-19 during the Omicron wave, particularly those less than 5 years old, were at risk for hospitalization. A majority of hospitalizations were directly related to COVID-19 infection although clinical indications varied with less than a half being admitted for respiratory diseases including croup. Our findings underscore the need for an effective COVID-19 vaccine in those less than 5 years old, continued monitoring for changes in clinical outcomes and health care utilization in children as more SARS-CoV-2 variants emerge, and understanding that children are often admitted for non-respiratory diseases with COVID-19.

BackgroundSequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic.Research questionAre SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients?Study design and methodsRetrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as ResultsOf 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11-1.99).InterpretationGiven current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.

BackgroundThe COVID-19 pandemic has had a devastating impact in the United States, particularly for Black populations, and has heavily burdened the healthcare system. Hospitals have created protocols to allocate limited resources, but there is concern that these protocols will exacerbate disparities. The sequential organ failure assessment (SOFA) score is a tool often used in triage protocols. In these protocols, patients with higher SOFA scores are denied resources based on the assumption that they have worse clinical outcomes. The purpose of this study was to assess whether using SOFA score as a triage tool among COVID-positive patients would exacerbate racial disparities in clinical outcomes.MethodsWe analyzed data from a retrospective cohort of hospitalized COVID-positive patients in the Yale-New Haven Health System. We examined associations between race/ethnicity and peak overall/24-hour SOFA score, in-hospital mortality, and ICU admission. Other predictors of interest were age, sex, primary language, and insurance status. We used one-way ANOVA and chi-square tests to assess differences in SOFA score across racial/ethnic groups and linear and logistic regression to assess differences in clinical outcomes by sociodemographic characteristics.ResultsOur final sample included 2,554 patients. Black patients had higher SOFA scores compared to patients of other races. However, Black patients did not have significantly greater in-hospital mortality or ICU admission compared to patients of other races.ConclusionWhile Black patients in this sample of hospitalized COVID-positive patients had higher SOFA scores compared to patients of other races, this did not translate to higher in-hospital mortality or ICU admission. Results demonstrate that if SOFA score had been used to allocate care, Black COVID patients would have been denied care despite having similar clinical outcomes to white patients. Therefore, using SOFA score to allocate resources has the potential to exacerbate racial inequities by disproportionately denying care to Black patients and should not be used to determine access to care. Healthcare systems must develop and use COVID-19 triage protocols that prioritize equity.

Introduction The medical community recognizes the importance of confronting structural racism and implicit bias to address health inequities. Several curricula aimed at teaching trainees about these issues are described in the literature. However, few curricula exist that engage faculty members as learners rather than teachers of these topics or target interdisciplinary audiences. Methods We developed a longitudinal case conference curriculum called Health Equity Rounds (HER) to discuss and address the impact of structural racism and implicit bias on patient care. The curriculum engaged participants across training levels and disciplines on these topics utilizing case-based discussion, evidence-based exercises, and two relevant conceptual frameworks. It was delivered quarterly as part of a departmental case conference series. We evaluated HER's feasibility and acceptability by tracking conference attendance and administering postconference surveys. We analyzed quantitative survey data using descriptive statistics and qualitatively reviewed free-text comments. Results We delivered seven 1-hour HER conferences at our institution from June 2016 to June 2018. A mean of 66 participants attended each HER. Most survey respondents (88% or more) indicated that HER promoted personal reflection on implicit bias, and 75% or more indicated that HER would impact their clinical practice. Discussion HER provided a unique forum for practitioners across training levels to address structural racism and implicit bias. Our aim in dissemination is to provide meaningful tools for others to adapt at their own institutions, recognizing that HER should serve as a component of larger, multifaceted efforts to decrease structural racism and implicit bias in health care.