Search

We hypothesized that an electronic sepsis alert would decrease mortality, ICU admission, vasoactive use, and organ dysfunction at day 3 and day 7. Sepsis episodes were identified by a validated computational algorithm which reflects presence of infection with organ dysfunction (cardiac, respiratory, hematologic or renal) using data in the electronic health record. B Introduction: b Pediatric sepsis is a significant cause of morbidity and mortality in children; guidelines now recommend a systematic screening tool to enhance early recognition of children with sepsis. [Extracted from the article]

B Introduction: b Racial, ethnic, and socioeconomic (SES) disparities are reported in sepsis, with increased mortality for minority and low SES groups. Patients with higher social disorganization had lower odds of mortality (Quintile 3 0.68 [0.49-0.92]; Quintile 4 0.74, [0.55-1.01]; Quintile 5 0.7 [0.51-0.95]). [Extracted from the article]

Objectives: Acute brain dysfunction (ABD) in pediatric sepsis has a prevalence of 20%, but can be difficult to identify. Our previously validated ABD computational phenotype (CP ABD ) used variables obtained from the electronic health record indicative of clinician concern for acute neurologic or behavioral change. We tested whether the CP ABD has better diagnostic performance to identify confirmed ABD than other definitions using the Glasgow Coma Scale or delirium scores., Design: Diagnostic testing in a curated cohort of pediatric sepsis/septic shock patients., Setting: Quaternary freestanding children's hospital., Subjects: The test dataset comprised 527 children with sepsis/septic shock managed between 2011 and 2021 with a prevalence (pretest probability) of confirmed ABD of 30% (159/527)., Measurements and Main Results: CP ABD was based on use of neuroimaging, electroencephalogram, and/or administration of new antipsychotic medication. We compared the performance of the CP ABD with three GCS/delirium-based definitions of ABD-Proulx et al, International Pediatric Sepsis Consensus Conference, and Pediatric Organ Dysfunction Information Update Mandate. The posttest probability of identifying ABD was highest in CP ABD (0.84) compared with other definitions. CP ABD also had the highest sensitivity (83%; 95% CI, 76-89%) and specificity (93%; 95% CI, 90-96%). The false discovery rate was lowest in CP ABD (1-in-6) as was the false omission rate (1-in-14). Finally, the prevalence threshold for the definitions varied, with the CP ABD being the definition closest to 20%., Conclusions: In our curated dataset of pediatric sepsis/septic shock, CP ABD had favorable characteristics to identify confirmed ABD compared with GCS/delirium-based definitions. The CP ABD can be used to further study the impact of ABD in studies using large electronic health datasets., Competing Interests: This project was supported by the Children’s Hospital of Philadelphia Research Institute, the National Center for Research Resources, and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant UL1TR001878 (Dr. Alcamo). Dr. Fitzgerald was supported by the National Institute of Health (NIH) K23KD119463. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Drs. Alcamo and Pennington received support for article research from the NIH. Dr. Pennington’s institution received funding from the NIH. Dr. Topjian received funding as an expert witness. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)

Objectives: This study aimed to determine the prevalence of sexually transmitted infections (STIs) in symptomatic adolescent female patients presenting to a pediatric emergency department (ED). Secondary objectives included determining correlates of infection., Methods: This was a prospective prevalence study of a consecutive sample of female patients aged 14 to 19 years presenting to a pediatric ED with lower-abdominal or genitourinary complaints between August 2009 and January 2010. Patients were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. Descriptive statistics, sensitivity analysis to account for untested patients, and logistic regression to understand correlates of STI were performed., Results: A total of 276 patients met inclusion criteria; 236 underwent STI testing. The prevalence of any STI was 26.3% (95% confidence interval [CI], 20.6%-31.9%) among patients who had testing performed, with C. trachomatis infection being most prevalent (19.7%; 95% CI, 14.5%-24.9%). Assuming all eligible patients who did not undergo STI testing were not infected, sensitivity analysis revealed a minimum STI prevalence of 22.5% (95% CI, 17.5%-27.4%). Multivariable logistic regression revealed no significant association between STI and patient age, chief complaint, or insurance status. There was a significant association between STI and black or African-American race (odds ratio, 9.5; 95% CI, 2.1-44.1)., Conclusions: A large percentage of our study population had an STI, and therefore, STI testing should be considered in all symptomatic adolescent ED female patients. Future studies should focus on understanding barriers to STI testing and designing interventions to increase testing within an adolescent ED population.

Objective: To explore the attitudes of urban, minority adolescent girls about an emergency department (ED)-based intervention to address emergency contraceptive pill (ECP) use., Methods: We conducted an in-depth, semistructured interview study of healthy, 15- to 19-year-old African-American girls seeking care in a children's hospital ED. Purposive sampling was used to recruit sexually and nonsexually active adolescents and those with or without a history of pregnancy. We collected demographic data and opinions about an ED-based intervention addressing ECP use. A modified grounded theory approach was used for analysis., Results: Thirty interviews were completed. Mean participant age was 16.4 years; 53% reported sexual activity; and 17% reported a history of pregnancy. Most participants expressed that an intervention focused on ECP would be useful in the ED setting, but this varied depending upon the type of ED visit. For example, although most believed that patients with symptoms related to sexual activity should be offered an ECP intervention, fewer stated that this type of intervention would be appropriate for patients presenting with headache or an injury. Participants stated that the information could be delivered by a health care professional or a peer counselor, although no particular delivery modality was clearly favored., Conclusions: Urban, minority adolescent girls are generally supportive of learning about ECP during an ED visit. Preferences about the appropriateness of the intervention related to the type of patient complaint. Because multiple sources and delivery modalities were acceptable, future studies should determine whether tailoring the source and delivery modality to demographic characteristics enhances the uptake of the message.