18 results on '"Yiannis L. Katsogridakis"'
Search Results
2. 1332. Population structure and genomic analysis of pediatric Streptococcus pyogenes clinical isolates in the United States, 2020 – 2022
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Egon A Ozer, Samuel W Gatesy, Ami B Patel, Judith A Guzman-Cottrill, Katherine E Fleming-Dutra, Sopio Chochua, Bernard Beall, Preeti Jaggi, Christine L Inguglia, Yiannis L Katsogridakis, Stanford Shulman, Robert R Tanz, and Jason Rippe more...
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Infectious Diseases ,Oncology - Abstract
Background Streptococcus pyogenes (GAS) is the major cause of bacterial pharyngitis in children. GAS can cause conditions ranging from asymptomatic pharyngeal carriage to invasive infection. We compared the genomic characteristics of GAS pharyngeal and invasive isolates from U.S. children. Methods We cultured GAS from throat swabs collected from children aged 3–18 years with acute GAS pharyngitis, diagnosed by rapid antigen or molecular test, and from a convenience sample of asymptomatic children during 1/2020 to 3/2022 in Chicago, IL; Atlanta, GA; Portland, OR; Phoenix, AZ. We collected invasive isolates in Chicago. Whole-genome sequencing (WGS) was performed on the Illumina MiSeq for species confirmation, isolate typing, and virulence and antimicrobial gene identification. Reference-based read alignment was used for whole genome phylogenetic analysis. Results Of 1144 collected throat swabs, 684 were from children with pharyngitis and 460 from asymptomatic children. 13 invasive GAS isolates were collected. GAS were cultured from 359 pharyngitis and 20 asymptomatic swabs. Of these, 371 GAS isolates could be recovered and underwent WGS. Thirty isolates (8%) were either low-quality sequences and/or identified as species other than S. pyogenes and were excluded. Whole-genome phylogenetic analysis of 341 GAS (215 pharyngitis, 13 asymptomatic, 13 invasive) identified 25 related clusters and 8 singletons (Figure 1). Virulence gene complements within given emm types were generally concordant with recently published CDC strain data. The most frequently identified resistance genes were tetM and ermB. 281 isolates (82%) carried no antibiotic resistance genes. Some clusters were significantly more represented at certain sites within apparent geographically defined clusters of nearly indistinguishable isolates (Figure 1): cluster 1 in Chicago, emm type 3; cluster 14 in Phoenix and Portland, emm 28, 12; and cluster 15 in Atlanta, emm 89. No major genomic factors were significantly associated with asymptomatic vs pharyngitis vs invasive presentation. Figure 1:Whole genome phylogenetic tree of pediatric GAS isolates Maximum likelihood phylogenetic analysis based on whole-genome alignment of 371 Group A Streptococcus isolates. Tip colors represent cluster assignments based on genetic similarity. Inner ring represents geographic location of GAS isolation. Outer ring represents patient presentation: asymptomatic colonization, symptomatic pharyngitis, or invasive infection. Conclusion Pharyngeal and invasive GAS in children within individual clonal complexes are co-included in closely related clusters, with evidence of close transmission within individual sites Disclosures All Authors: No reported disclosures. more...
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- 2022
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3. 1321. Increased Prevalence of Group A Streptococcus (GAS) High Level Macrolide Resistance During the COVID-19 Pandemic
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Ami B Patel, Judith A Guzman-Cottrill, Katherine E Fleming-Dutra, Sopio Chochua, Bernard Beall, Preeti Jaggi, Jason Rippe, Christine L Inguglia, Yiannis L Katsogridakis, Egon A Ozer, Stanford Shulman, and Robert R Tanz more...
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Infectious Diseases ,Oncology - Abstract
Background COVID-19 affected the epidemiology of many respiratory pathogens including GAS. Assessing genetic heterogeneity (emm type, antimicrobial resistance, virulence factors) can inform treatment recommendations and targets for potential GAS vaccines. We assessed GAS clinical antibiotic susceptibility and performed whole genome sequencing (WGS) among pediatric pharyngeal isolates from 2020–2022. Methods From 1/2020–3/2022 we collected throat swabs in pediatric clinics and EDs from children aged 3-18 years in Chicago, IL; Atlanta, GA; Portland, OR; and Phoenix, AZ: 1) with acute GAS pharyngitis and 2) among a convenience sample of asymptomatic children to assess for GAS colonization. Swabs were plated on blood agar. E-tests were used to assess clinical susceptibility to erythromycin (ERY) and ciprofloxacin (CIP). emm type and antimicrobial resistance genes (ERY, Clindamycin (CLI), and fluoroquinolones) were assessed by WGS. Results 1144 pharyngeal swabs were collected: 359/684 (52%) from children with GAS pharyngitis by rapid test and 20/460 (4.3%) from asymptomatic children yielded GAS on culture. Phenotypic resistance: 55/364 (15%) tested isolates were ERY resistant and 5/364 (1.4%) CIP resistant. The proportion of isolates with ERY resistance increased significantly from 2020 (6%) to 2021–2022 (25%) (χ2 = 23.70, p< .00001) (Figure 1). MICs were high among ERY resistant GAS (Table 1). Genotypic resistance: Of 304 sequenced GAS isolates 40/304 (13%) were ERY resistant, 35/304 (11.5%) were both ERY resistant and CLI (inducible or constitutive) resistant, and 4/304 (1.3%) fluoroquinolone resistant. ermB (62%) was the most common gene for ERY resistance and constitutive CLI resistance, followed by ermTR (23%) and ermT (11%) both conferring inducible CLI resistance. Among the 20 isolates from asymptomatic children no ERY, CLI, or CIP resistance occurred, and no resistance genes were identified. emm types 11, 9, 77, 58 and 94 were associated with ERY and CLI resistance. Conclusion ERY resistance increased from 2020–2022. The high rate of CLI resistance among ERY resistant GAS was associated with erm genes. These results are important to inform treatment recommendations for GAS pharyngitis and targets for vaccine development that can reduce antimicrobial-resistant GAS disease. Disclosures All Authors: No reported disclosures. more...
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- 2022
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4. Brief resolved unexplained events: a new diagnosis, with implications for evaluation and management
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Raymond D. Pitetti, Jennifer Y. Colgan, Sriram Ramgopal, Damian Roland, and Yiannis L. Katsogridakis
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Guideline ,Pallor ,Hypotonia ,Diagnosis of exclusion ,Review article ,Pediatrics, Perinatology and Child Health ,medicine ,Etiology ,Cardiopulmonary resuscitation ,medicine.symptom ,Intensive care medicine ,Airway ,business - Abstract
Brief resolved unexplained events (BRUE) are concerning episodes of short duration (typically
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- 2021
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5. Risk Factors and Outcomes After a Brief Resolved Unexplained Event: A Multicenter Study
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Emily R Kane, Joel S. Tieder, Allayne Stephans, Amy M. DeLaroche, Shobhit Jain, Joyee G. Vachani, Nirav Shastri, Matthew Hall, Yiannis L. Katsogridakis, Edward E. Kim, Jessica Nicholson, Kathleen Murphy, Daniela Hochreiter, Mark I. Neuman, Erin Sullivan, Victoria Wilkins, Manoj K. Mittal, and Risa Bochner more...
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Male ,Pediatrics ,medicine.medical_specialty ,MEDLINE ,Brief, Resolved, Unexplained Event ,Patient Readmission ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Risk Factors ,Seizures ,Airway abnormalities ,030225 pediatrics ,medicine ,Craniocerebral Trauma ,Humans ,Medical history ,Medical diagnosis ,Respiratory Tract Infections ,Risk criteria ,Retrospective Studies ,Event (probability theory) ,business.industry ,Infant ,Retrospective cohort study ,Airway Obstruction ,Multicenter study ,Pediatrics, Perinatology and Child Health ,Female ,Emergency Service, Hospital ,business ,Spasms, Infantile - Abstract
BACKGROUND The accuracy of the risk criteria for brief resolved unexplained events (BRUEs) from the American Academy of Pediatrics (AAP) is unknown. We sought to evaluate if AAP risk criteria and event characteristics predict BRUE outcomes. METHODS This retrospective cohort included infants RESULTS Of 2036 patients presenting with a BRUE, 87% had at least 1 AAP higher-risk factor. Revisits occurred in 6.9% of ED and 10.7% of hospital discharges. A serious diagnosis was made in 4.0% (82) of cases; 45% (37) of these diagnoses were identified after the index visit. The most common serious diagnoses included seizures (1.1% [23]) and airway abnormalities (0.64% [13]). Risk is increased for a serious underlying diagnosis for patients discharged from the ED with a history of a similar event, an event duration >1 minute, an abnormal medical history, and an altered responsiveness (P < .05). AAP risk criteria for all outcomes had a negative predictive value of 90% and a positive predictive value of 23%. CONCLUSIONS AAP BRUE risk criteria are used to accurately identify patients at low risk for event recurrence, readmission, and a serious underlying diagnosis; however, their use results in the inaccurate identification of many patients as higher risk. This is likely because many AAP risk factors, such as age, are not associated with these outcomes. more...
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- 2021
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6. Electronic medical record-based tools aid in timely triage of disc-shaped foreign body ingestions
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Jennifer M. Lavin, Alexandra Sals, Agata Nytko, Jonathan B. Ida, Dusty Brinson, Steven E. Krug, Yiannis L. Katsogridakis, Joshua Wiedermann, and Kimberly Kato
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medicine.medical_specialty ,business.industry ,Poison control ,030208 emergency & critical care medicine ,Evidence-based medicine ,Emergency department ,Clinical decision support system ,Triage ,Occupational safety and health ,Confidence interval ,03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,030225 pediatrics ,Emergency medicine ,Injury prevention ,medicine ,business - Abstract
Objectives/hypothesis Children presenting to the emergency department with coin-shaped foreign body (FB) ingestion must be evaluated urgently to rule out a button battery. As many of these ingestions are well-appearing on presentation, delays in triage put patients at risk for further injury. Study design Quality initiative. Methods A quality initiative, utilizing electronic medical record (EMR)-based tools, was implemented at our academic children's hospital. A chief complaint pertaining to coin-shaped FB ingestion was created and was linked to a best practice advisory, instructing assignment of acuity level 2 and the order of a Stat x-ray. A link to the hospital's relevant algorithm was provided. A review was conducted comparing children who underwent FB removal preinitiative (January 1, 2016-January 28, 2017) and postinitiative (January 31, 2017-August 30, 2017). Primary outcomes were frequency of assignment of acuity level 2 and time from patient arrival to x-ray order placement and x-ray completion. Results Thirty-six patients in the baseline group and 30 in the postintervention group underwent FB removal. The rate of appropriate acuity assignment increased from 63.8% (23/36) pre implementation to 100% (30/30) postimplementation (P = .0003). Median time from arrival to imaging ordered and completed decreased from 36.5 to 4 minutes (95% confidence interval [CI]: -44 to -17) and 59 to 41 minutes (95% CI: -39 to -1), respectively. Conclusions Utilization of EMR-based tools was associated with improved timeliness in initiation of care in metallic FB ingestion patients. Further initiatives will be aimed at downstream events in the diagnosis and treatment of these patients. Level of evidence NA Laryngoscope, 128:2697-2701, 2018. more...
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- 2018
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7. Predicting Low-Resource-Intensity Emergency Department Visits in Children
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Eyal Cohen, Stephen B. Freedman, Paul L. Aronson, Margaret E. Samuels-Kalow, Elizabeth R. Alpern, Rustin B. Morse, Yiannis L. Katsogridakis, Jonathan Rodean, Matthew Hall, Mark I. Neuman, Jay G. Berry, Kathy N. Shaw, Alon Peltz, Samir S. Shah, and Harold K. Simon more...
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Male ,medicine.medical_specialty ,Adolescent ,Population ,Health Services Misuse ,Risk Assessment ,Severity of Illness Index ,Odds ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Odds Ratio ,medicine ,Humans ,Multiple Chronic Conditions ,Child ,education ,Retrospective Studies ,education.field_of_study ,Medicaid ,business.industry ,Infant ,030208 emergency & critical care medicine ,Retrospective cohort study ,Odds ratio ,Emergency department ,United States ,Confidence interval ,Area Under Curve ,Child, Preschool ,Acute Disease ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Linear Models ,Female ,Emergency Service, Hospital ,Risk assessment ,business ,Cohort study - Abstract
Objectives Interventions to reduce frequent emergency department (ED) use in children are often limited by the inability to predict future risk. We sought to develop a population-based model for predicting Medicaid-insured children at risk for high frequency (HF) of low-resource-intensity (LRI) ED visits. Methods We conducted a retrospective cohort analysis of Medicaid-insured children (aged 1–18 years) included in the MarketScan Medicaid database with ≥1 ED visit in 2013. LRI visits were defined as ED encounters with no laboratory testing, imaging, procedures, or hospitalization; and HF as ≥3 LRI ED visits within 365 days of the initial encounter. A generalized linear regression model was derived and validated using a split-sample approach. Validity testing was conducted examining model performance using 3 alternative definitions of LRI. Results Among 743,016 children with ≥1 ED visit in 2013, 5% experienced high-frequency LRI ED use, accounting for 21% of all LRI visits. Prior LRI ED use (2 visits: adjusted odds ratio = 3.5; 95% confidence interval, 3.3, 3.7; and ≥3 visits: adjusted odds ratio = 7.7; 95% confidence interval, 7.3, 8.1) and presence of ≥3 chronic conditions (adjusted odds ratio = 1.7; 95% confidence interval, 1.6, 1.8) were strongly associated with future HF-LRI ED use. A model incorporating patient characteristics and prior ED use predicted future HF-LRI ED utilization with an area under the curve of 0.74. Conclusions Demographic characteristics and patterns of prior ED use can predict future risk of HF-LRI ED use in the following year. Interventions for reducing low-value ED use in these high-risk children should be considered. more...
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- 2018
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8. Optimizing Interdisciplinary Care of Pediatric Sexual Assault and Abuse in the Emergency Department: A Quality Improvement Approach
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Jose Celio, Kate Balsley, Kirsten Simonton, Sheila Hickey Msw, Lisa Mathey, and Yiannis L. Katsogridakis
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Quality management ,Sexual Assault Nurse Examiner ,business.industry ,education ,Psychological intervention ,030208 emergency & critical care medicine ,Emergency department ,Guideline ,Project team ,Clinical decision support system ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Sexual abuse ,030225 pediatrics ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,Medicine ,business - Abstract
The Ann & Robert H. Lurie Children's Hospital of Chicago identified issues with team communication, consistency of services provided, and continuity of care within the sexual abuse and assault program in the emergency department (ED) which necessitated improvement efforts. The aim of this project was to engage an interdisciplinary team to define and delineate roles and streamline clinical workflows from ED presentation to nonacute follow-up. An interdisciplinary team was convened and utilized quality improvement methodology to complete a current state analysis, develop a future state design, and prioritize interventions for improvement. The project team focused on four interventions: (1) establish a team approach with delineated roles and responsibilities; (2) develop and implement consistent workflows to reduce unwarranted variation in care; (3) expand education on the sexual assault nurse examiner (SANE) program more broadly to the care teams in the ED; and (4) implement clinical decision support (CDS) tools to streamline the continuum of sexual assault services provided. Three of the interventions (all but education) were carried out as a comprehensive care guideline for patients presenting to the ED for evaluation. The ED implemented this care guideline in August 2019. The utilization of quality improvement methodology was effective in ensuring an organized, interdisciplinary team response for the evaluation of pediatric and adolescent sexual abuse and assault in the ED. It enabled strong buy-in from team members and ownership of the process with anticipated improvements in patient care and experiences. more...
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- 2020
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9. Characteristics of Children Enrolled in Medicaid With High-Frequency Emergency Department Use
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Eyal Cohen, Yiannis L. Katsogridakis, Jay G. Berry, Stephen B. Freedman, Kathy N. Shaw, Alon Peltz, Margaret E. Samuels-Kalow, Samir S. Shah, Matthew Hall, Paul L. Aronson, Mark I. Neuman, Jonathan Rodean, Rustin B. Morse, Elizabeth R. Alpern, and Harold K. Simon more...
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Male ,medicine.medical_specialty ,Adolescent ,Poison control ,Article ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Injury prevention ,Humans ,Medicine ,Longitudinal Studies ,Multiple Chronic Conditions ,Child ,Retrospective Studies ,Medicaid ,business.industry ,Infant ,030208 emergency & critical care medicine ,Retrospective cohort study ,Odds ratio ,Emergency department ,United States ,Confidence interval ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Female ,Emergency Service, Hospital ,business - Abstract
BACKGROUND AND OBJECTIVES: Some children repeatedly use the emergency department (ED) at high levels. Among Medicaid-insured children with high-frequency ED use in 1 year, we sought to describe the characteristics of children who sustain high-frequency ED use over the following 2 years. METHODS: Retrospective longitudinal cohort study of 470 449 Medicaid-insured children appearing in the MarketScan Medicaid database, aged 1–16 years, with ≥1 ED discharges in 2012. Children with high ED use in 2012 (≥4 ED discharges) were followed through 2014 to identify characteristics associated with sustained high ED use (≥8 ED discharges in 2013–2014 combined). A generalized linear model was used to identify patient characteristics associated with sustained high ED use. RESULTS: A total of 39 945 children (8.5%) experienced high ED use in 2012, accounting for 25% of total ED visits in 2012. Sixteen percent of these children experienced sustained high ED use in the following 2 years. Adolescents (adjusted odds ratio [aOR]: 1.4 [95% confidence interval: 1.3–1.5]), disabled children (aOR: 1.3 [95% confidence interval: 1.1–1.5]), and children with 3 or more chronic conditions (aOR: 2.1, [95% confidence interval: 1.9–2.3]) experienced the highest likelihood for sustaining high ED use. CONCLUSIONS: One in 6 Medicaid-insured children with high ED use in a single year experienced sustained high levels of ED use over the next 2 years. Adolescents and individuals with multiple chronic conditions were most likely to have sustained high rates of ED use. Targeted interventions may be indicated to help reduce ED use among children at high risk. more...
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- 2017
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10. Delayed Diagnoses in Children with Constipation: Multicenter Retrospective Cohort Study
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Elizabeth R. Alpern, Samir S. Shah, Jennifer R. Marin, Eyal Cohen, Mark I. Neuman, Rustin B. Morse, Harold K. Simon, Matthew Hall, Stephen B. Freedman, Paul L. Aronson, Jonathan Rodean, Jay G. Berry, and Yiannis L. Katsogridakis more...
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Male ,Radiography, Abdominal ,Pediatrics ,medicine.medical_specialty ,Constipation ,Delayed Diagnosis ,Adolescent ,Narcotic ,medicine.drug_class ,medicine.medical_treatment ,Patient Readmission ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Antiemetic ,Humans ,030212 general & internal medicine ,Medical diagnosis ,Child ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Age Factors ,Complete blood count ,030208 emergency & critical care medicine ,Retrospective cohort study ,Emergency department ,medicine.disease ,humanities ,Appendicitis ,Pediatrics, Perinatology and Child Health ,Female ,medicine.symptom ,business ,Emergency Service, Hospital - Abstract
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.Retrospective cohort study of children aged18 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.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).Among children diagnosed with constipation, abdominal radiograph performance is associated with an increased risk of a revisit with a clinically important alternate related diagnosis. more...
- Published
- 2017
11. Multidisciplinary Quality Improvement Approach to Standardize Care and Communication for Suspected Child Abuse Arriving to the ED
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Sheila Hickey, Kate Balsley, Mary Clyde Pierce, Norell Rosado, Michael D. Kelleher, Yiannis L. Katsogridakis, and Lisa Mathey
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Child abuse ,Quality management ,ComputingMilieux_THECOMPUTINGPROFESSION ,Social work ,business.industry ,030208 emergency & critical care medicine ,Emergency department ,Guideline ,medicine.disease ,Transparency (behavior) ,Project team ,03 medical and health sciences ,0302 clinical medicine ,Multidisciplinary approach ,030225 pediatrics ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,Medicine ,Medical emergency ,business - Abstract
The Ann & Robert H. Children's Hospital of Chicago identified dissatisfaction with communication, expectations, and care during evaluation for suspected child abuse, which requires coordination among emergency department (ED) providers, child abuse pediatricians (CAPs), and social workers. The aim of this project was to develop and implement standard care and communication in the evaluation of suspected child abuse. A multi-disciplinary project team was convened and utilized quality improvement methodology to complete a barriers assessment and gap analysis. The project team developed a guideline with clear criteria and decision points. A scripting tool was also designed to standardize communication and increase transparency with families. The ED implemented this guideline for suspected child abuse in December 2018. Employing a quality improvement approach to streamlining communication and care for children presenting to the ED for suspected child abuse was effective for ensuring buy-in from team members. more...
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- 2019
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12. Diagnostic Value of Immature Neutrophils (Bands) in the Cerebrospinal Fluid of Children With Cerebrospinal Fluid Pleocytosis
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Jonathan E. Bennett, Michael Mohseni, Lise E. Nigrovic, Christopher R. Cannavino, Sandra H. Schwab, Yiannis L. Katsogridakis, Richard Malley, John T. Kanegaye, Vincent J. Wang, Martin I. Herman, and Nathan Kuppermann more...
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Male ,Pathology ,medicine.medical_specialty ,Adolescent ,Leukocytosis ,Neutrophils ,Meningitis, Bacterial ,Leukocyte Count ,Young Adult ,Cerebrospinal fluid ,CSF pleocytosis ,Predictive Value of Tests ,Confidence Intervals ,medicine ,Humans ,Meningitis, Aseptic ,Child ,CSF albumin ,business.industry ,Infant, Newborn ,Infant ,Aseptic meningitis ,medicine.disease ,Confidence interval ,ROC Curve ,Area Under Curve ,Child, Preschool ,Predictive value of tests ,Pediatrics, Perinatology and Child Health ,Female ,Emergency Service, Hospital ,business ,Meningitis ,Immature neutrophils - Abstract
OBJECTIVE. We evaluated the diagnostic utility of the presence and number of cerebrospinal fluid (CSF) bands in distinguishing bacterial from aseptic meningitis among children with CSF pleocytosis.METHODS. We identified retrospectively a cohort of children 29 days to 19 years of age with CSF pleocytosis (≥10 × 106 leukocytes per L) who were treated in the emergency departments of 8 pediatric centers between January 2001 and June 2004 and whose CSF was evaluated for the presence of bands. We performed bivariate and multivariate analyses to determine the ability of CSF bands to distinguish bacterial from aseptic meningitis.RESULTS. Among 1116 children whose CSF was evaluated for the presence of bands, 48 children (4% of study patients) had bacterial meningitis. Bacterial meningitis, compared with aseptic meningitis, was associated with a greater CSF band proportion (0.03 vs 0.01; difference: 0.02; 95% confidence interval: 0.00–0.04) and CSF absolute band count (392 × 106 cells per L vs 3 × 106 cells per L; difference: 389 × 106 cells per L; 95% confidence interval: −77 × 106 cells per L to 855 × 106 cells per L). In addition, 29% of patients with bacterial meningitis, compared with 18% of patients with aseptic meningitis, had any bands detected in the CSF. After adjustment for other factors associated with bacterial meningitis, however, CSF band presence, CSF absolute band count, and CSF band proportion were not independently associated with bacterial meningitis.CONCLUSION. In this multicenter study, neither the presence nor quantity of CSF bands independently predicted bacterial meningitis among children with CSF pleocytosis. more...
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- 2009
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13. Empiric Antibiotics for the Complex Febrile Child: When, Why, and What to Use
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Kristine L. Cieslak and Yiannis L. Katsogridakis
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medicine.medical_specialty ,business.industry ,medicine.drug_class ,Antibiotics ,Signs and symptoms ,Emergency department ,Neutropenia ,Short bowel syndrome ,medicine.disease ,Cystic fibrosis ,Patient care ,Pediatric emergency medicine ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,Medicine ,business ,Intensive care medicine - Abstract
There are multiple patient care scenarios where empiric antibiotics are indicated in the practice of pediatric emergency medicine. Patients with fever and neutropenia, ventriculoperitoneal shunt(s), cystic fibrosis, and short bowel syndrome are unique patient populations that are often instructed to seek further evaluation for any concerns of possible infection. When seen in the emergency department, fever is usually the presenting complaint; however, they may also present with more subtle signs and symptoms of infection that require prompt evaluation. This article briefly reviews these 4 unique patient populations as well as when, why, and what empiric antibiotics are often used to treat them. more...
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- 2008
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14. Veinlite Transillumination in the Pediatric Emergency Department
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Mark L. Waltzman, Yiannis L. Katsogridakis, Roopa Seshadri, and Christine Sullivan
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Male ,Pediatric emergency ,medicine.medical_specialty ,Resuscitation ,Adolescent ,Peripheral intravenous ,Transillumination ,law.invention ,Randomized controlled trial ,law ,Intensive care ,medicine ,Fiber Optic Technology ,Humans ,Prospective Studies ,Child ,Infusions, Intravenous ,Intensive care medicine ,Prospective cohort study ,Lighting ,business.industry ,Infant, Newborn ,Infant ,General Medicine ,Emergency department ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Emergency medicine ,Emergency Medicine ,Female ,Emergency Service, Hospital ,business - Abstract
We hypothesized that transillumination would increase peripheral intravenous (IV) insertion success rates in pediatric emergency department patients. Primary outcome was success in first attempt, and secondary outcome was success within 2 attempts.We evaluated IV insertion by pediatric emergency department physicians and nurses using the Veinlite (TransLite, Sugar Land, Tex). Patients who required nonemergent IV insertion were enrolled if younger than 3 years or aged 3 to 21 years with a history of difficult access. Participants were randomly assigned to transillumination or nontransillumination. Analyses were performed using a mixed-effects logistic regression model adjusting for provider effect.We evaluated 240 patients. After adjusting for significant covariates (safety catheter [P = 0.008], visibility [P = 0.01], and palpability [P = 0.03]) and controlling for provider effect, IV placement was more likely successful in first attempt in transilluminated patients (P = 0.03; odds ratio, 2.1 [95% confidence interval, 1.1-3.9]). After adjusting for significant covariates (safety catheter [P0.001], location [P = 0.005], and palpability [P = 0.05]) and controlling for provider effect, IV placement was more likely successful within 2 attempts in transilluminated patients (P = 0.01; odds ratio, 3.5 [95% confidence interval, 1.4-8.9]). Intracluster correlation for random effect of provider was 10% in first attempt and 16% within 2 attempts.After adjusting for multiple significant covariates and controlling for random effect of provider, our results indicated a benefit in the use of Veinlite transillumination for IV insertion in first attempt and within 2 attempts. This technique seemed to facilitate nonemergent IV placement in pediatric patients compared with standard practice. more...
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- 2008
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15. Educational Module Improves Emergency Department Evaluation for Suspected Constipation
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Jacob Kurowski, Barry K. Wershil, Yiannis L. Katsogridakis, Sunpreet Kaur, and Lee M. Bass
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Male ,Radiography, Abdominal ,medicine.medical_specialty ,Abdominal pain ,Constipation ,Inservice Training ,Adolescent ,Abdominal radiograph ,Cost Savings ,Chart review ,Medical Staff ,Medicine ,Humans ,Nurse Practitioners ,Child ,Digital Rectal Examination ,Retrospective Studies ,Chicago ,medicine.diagnostic_test ,business.industry ,Rectal examination ,Emergency department ,Surgery ,Cost savings ,Abdominal Pain ,Radiation exposure ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,medicine.symptom ,business ,Emergency Service, Hospital - Abstract
Objectives To determine abdominal radiograph use and frequency of digital rectal examinations in children presenting to the emergency department (ED) with abdominal pain and suspected constipation and to determine the impact of an educational module on their use. Study design Retrospective chart review of patients evaluated at a pediatric ED because of the complaint of abdominal pain who had the discharge diagnosis of constipation over two 2-month periods, one before and one after an educational module. Results Comparing pre- and posteducational module periods, there was a significant decrease in abdominal radiograph utilization (69.5% vs 26.4%, respectively, P ≤ .001) and significant increase in performance of digital rectal examination (22.9% vs 47.3%, respectively, P ≤ .001). We demonstrated a 33.6% reduction in abdominal radiograph in children who had a digital rectal examination as part of their examination. Overall, we demonstrated a 43.1% decrease in patients receiving an abdominal radiograph. When time and costs of an abdominal radiograph are considered, this results in significant cost savings. Conclusions An educational module reviewing the established criteria for the diagnosis of constipation and presented to ED providers results in increased use of digital rectal examination and decreased use of abdominal radiograph in patients evaluated for abdominal pain and ultimately diagnosed with constipation. The change also was associated with reduction in cost and time and radiation exposure in the ED for these patients. more...
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- 2015
16. Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis
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Karim M. Mansour, Ron L. Kaplan, Jennifer L. Chapman, Uyen T. Truong, Vince J. Wang, Lise E. Nigrovic, John T. Kanegaye, Sandra H. Schwab, Jonathan E. Bennett, Yiannis L. Katsogridakis, Blake Bulloch, Bema K. Bonsu, Nathan Kuppermann, Michael Mohseni, Dewesh Agrawal, Dale W. Steele, Charles G. Macias, Richard Malley, Robert D. Schremmer, Donna M. Moro-Sutherland, Martin I. Herman, Subhankar Bandyopadhyay, and Peter S. Dayan more...
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medicine.medical_specialty ,Adolescent ,Leukocytosis ,Gastroenterology ,Severity of Illness Index ,Spinal Puncture ,law.invention ,Meningitis, Bacterial ,Leukocyte Count ,Cerebrospinal fluid ,law ,Internal medicine ,medicine ,Humans ,Child ,CSF albumin ,Antibacterial agent ,Cerebrospinal Fluid ,Retrospective Studies ,medicine.diagnostic_test ,Bacteria ,Lumbar puncture ,business.industry ,Infant, Newborn ,Infant ,Proteins ,medicine.disease ,United States ,Latex fixation test ,Anti-Bacterial Agents ,Gram staining ,Glucose ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Immunology ,Absolute neutrophil count ,business ,Meningitis ,Biomarkers ,Follow-Up Studies - Abstract
OBJECTIVE. The goal of this study was to evaluate the effect of antibiotic administration before lumbar puncture on cerebrospinal fluid profiles in children with bacterial meningitis.METHODS. We reviewed the medical records of all children (1 month to 18 years of age) with bacterial meningitis who presented to 20 pediatric emergency departments between 2001 and 2004. Bacterial meningitis was defined by positive cerebrospinal fluid culture results for a bacterial pathogen or cerebrospinal fluid pleocytosis with positive blood culture and/or cerebrospinal fluid latex agglutination results. Probable bacterial meningitis was defined as positive cerebrospinal fluid Gram stain results with negative results of bacterial cultures of blood and cerebrospinal fluid. Antibiotic pretreatment was defined as any antibiotic administered within 72 hours before the lumbar puncture.RESULTS. We identified 231 patients with bacterial meningitis and another 14 with probable bacterial meningitis. Of those 245 patients, 85 (35%) had received antibiotic pretreatment. After adjustment for patient age, duration and severity of illness at presentation, and bacterial pathogen, longer duration of antibiotic pretreatment was not significantly associated with cerebrospinal fluid white blood cell count, cerebrospinal fluid absolute neutrophil count. However, antibiotic pretreatment was significantly associated with higher cerebrospinal fluid glucose and lower cerebrospinal fluid protein levels. Although these effects became apparent earlier, patients with ≥12 hours of pretreatment, compared with patients who either were not pretreated or were pretreated for CONCLUSIONS. In patients with bacterial meningitis, antibiotic pretreatment is associated with higher cerebrospinal fluid glucose levels and lower cerebrospinal fluid protein levels, although pretreatment does not modify cerebrospinal fluid white blood cell count or absolute neutrophil count results. more...
- Published
- 2008
17. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis
- Author
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Uyen T. Truong, Michael Mohseni, Robert D. Schremmer, Ron L. Kaplan, Blake Bulloch, Peter S. Dayan, John T. Kanegaye, Richard Malley, Christopher R. Cannavino, Jennifer L. Chapman, Yiannis L. Katsogridakis, Vincent J. Wang, Karim M. Mansour, Nathan Kuppermann, Sandra H. Schwab, Dale W. Steele, Bema K. Bonsu, Lise E. Nigrovic, Subhankar Bandyopadhyay, Martin I. Herman, Donna M. Moro-Sutherland, Dewesh Agrawal, Charles G. Macias, and Jonathan E. Bennett more...
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Male ,medicine.medical_specialty ,Adolescent ,Leukocytosis ,Clinical prediction rule ,Sensitivity and Specificity ,law.invention ,Decision Support Techniques ,Meningitis, Bacterial ,Pneumococcal Vaccines ,CSF pleocytosis ,law ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Humans ,Meningitis, Aseptic ,Pleocytosis ,Child ,CSF albumin ,Retrospective Studies ,business.industry ,Infant, Newborn ,Aseptic meningitis ,Infant ,Reproducibility of Results ,General Medicine ,medicine.disease ,Surgery ,Gram staining ,Pneumococcal vaccine ,Child, Preschool ,Absolute neutrophil count ,Female ,business - Abstract
ContextChildren with cerebrospinal fluid (CSF) pleocytosis are routinely admitted to the hospital and treated with parenteral antibiotics, although few have bacterial meningitis. We previously developed a clinical prediction rule, the Bacterial Meningitis Score, that classifies patients at very low risk of bacterial meningitis if they lack all of the following criteria: positive CSF Gram stain, CSF absolute neutrophil count (ANC) of at least 1000 cells/μL, CSF protein of at least 80 mg/dL, peripheral blood ANC of at least 10 000 cells/μL, and a history of seizure before or at the time of presentation.ObjectiveTo validate the Bacterial Meningitis Score in the era of widespread pneumococcal conjugate vaccination.Design, Setting, and PatientsA multicenter, retrospective cohort study conducted in emergency departments of 20 US academic medical centers through the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. All children aged 29 days to 19 years who presented at participating emergency departments between January 1, 2001, and June 30, 2004, with CSF pleocytosis (CSF white blood cells ≥10 cells/μL) and who had not received antibiotic treatment before lumbar puncture.Main Outcome MeasureThe sensitivity and negative predictive value of the Bacterial Meningitis Score.ResultsAmong 3295 patients with CSF pleocytosis, 121 (3.7%; 95% confidence interval [CI], 3.1%-4.4%) had bacterial meningitis and 3174 (96.3%; 95% CI, 95.5%-96.9%) had aseptic meningitis. Of the 1714 patients categorized as very low risk for bacterial meningitis by the Bacterial Meningitis Score, only 2 had bacterial meningitis (sensitivity, 98.3%; 95% CI, 94.2%-99.8%; negative predictive value, 99.9%; 95% CI, 99.6%-100%), and both were younger than 2 months old. A total of 2518 patients (80%) with aseptic meningitis were hospitalized.ConclusionsThis large multicenter study validates the Bacterial Meningitis Score prediction rule in the era of conjugate pneumococcal vaccine as an accurate decision support tool. The risk of bacterial meningitis is very low (0.1%) in patients with none of the criteria. The Bacterial Meningitis Score may be helpful to guide clinical decision making for the management of children presenting to emergency departments with CSF pleocytosis. more...
- Published
- 2007
18. DIAGNOSTIC VALUE OF IMMATURE NEUTROPHILS (BANDS) IN THE CEREBROSPINAL FLUID OF CHILDREN WITH PLEOCYTOSIS
- Author
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Nathan Kuppermann, Sandra H. Schwab, Michael Mohseni, Christopher R. Cannavino, Martin I. Herman, Lise E. Nigrovic, John T. Kanegaye, Vincent J. Wang, Richard Malley, Jonathan E. Bennett, and Yiannis L. Katsogridakis more...
- Subjects
Pathology ,medicine.medical_specialty ,Cerebrospinal fluid ,business.industry ,Pediatrics, Perinatology and Child Health ,Emergency Medicine ,medicine ,General Medicine ,Pleocytosis ,business ,Value (mathematics) ,CSF albumin ,Immature neutrophils - Published
- 2007
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