Pediatrics
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OBJECTIVE:Although unnecessary for children with headache and normal history, computed tomography (CT) scans are widely used. This study sought to determine current practice patterns of neuroimaging to diagnose pediatric headache in a variety of treatment settings and to identify factors associated with increased use of neuroimaging. METHODS:This retrospective claims analysis included children (aged 3-17 years) with ≥2 medical claims for headache. ⋯ Evaluation by a neurologist was strongly associated with a lower likelihood of CT scan compared with other provider specialties (odds ratio: 0.37; P < .01 [95% confidence interval: 0.30-0.46]). CONCLUSIONS:Use of CT scans to diagnose pediatric headache remains high despite existing guidelines, low diagnostic yield, and high potential risk. Implementing quality improvement initiatives to ensure that CT scans in children are performed only when truly indicated will reduce unnecessary exposure to ionizing radiation and associated cancer risks.
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Comparative Study
Comparative effectiveness of acellular versus whole-cell pertussis vaccines in teenagers.
During the 1990s, the United States switched from combined diphtheria, tetanus toxoids, whole-cell pertussis (DTwP) vaccines to combined acellular pertussis (DTaP) vaccines because of safety concerns. After a 2010-2011 pertussis outbreak, we sought to evaluate whether disease risk in 10 to 17 year olds differed between those who previously received DTwP from those who received DTaP. ⋯ Teenagers who received DTwP vaccines in childhood were more protected during a pertussis outbreak than were those who received DTaP vaccines.
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Review
Allergen-specific immunotherapy for pediatric asthma and rhinoconjunctivitis: a systematic review.
Subcutaneous immunotherapy (SCIT) is approved in the United States for the treatment of pediatric asthma and rhinitis; sublingual immunotherapy (SLIT) does not have regulatory approval but is used in clinical practice. The objective of this study was to systematically review the evidence regarding the efficacy and safety of SCIT and SLIT for the treatment of pediatric asthma and allergic rhinoconjunctivitis. ⋯ Evidence supports the efficacy of both SCIT and SLIT for the treatment of asthma and rhinitis in children.
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To characterize malpractice risk among US pediatricians. ⋯ Indemnity payments among pediatricians are infrequent but large, particularly in cases with permanent patient injury rather than death or temporary injury. The time required to resolve claims may be considered to be long.
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Children's hospitals represent a significant opportunity to reduce morbidity, mortality, and costs, particularly for children with complex chronic conditions (CCCs) who comprise a disproportionate and growing share of admissions, readmissions, and resource use. Most children with CCCs are in some way associated with a children's hospital, and the subspecialists who care for them are primarily concentrated in the ≈ 200 children's hospitals in the United States. Children's hospitals and their associated subspecialty clinics are uniquely positioned to achieve significant outcomes and cost savings through coordinated quality-improvement efforts. ⋯ Although much of their participation has been funded as "pay to participate" efforts by the hospitals themselves, most financial benefits accrue to payers. As health care reform becomes a reality and financial pressures intensify, it will become increasingly difficult for children's hospitals to serve as the primary source of support for networks. Partnerships between children's hospitals and national payers to support collaborative networks are needed, and these partnerships have the potential to significantly improve pediatric care and outcomes, particularly for children with CCCs.