Articles: pediatrics.
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Pediatr Crit Care Me · Aug 2023
Multicenter StudyAdmission Pao2 and Mortality Among PICU Patients and Select Diagnostic Subgroups.
Evaluate the relationship between admission Pa o2 and mortality in a large multicenter dataset and among diagnostic subgroups. ⋯ In a large multicenter pediatric cohort, admission Pa o2 demonstrates a tightly fitting quadratic relationship with mortality. The persistence of this relationship among some but not all diagnostic subgroups suggests the pathophysiology of certain disease states may modify the hyperoxemia association.
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Implementing pediatric-focused clinical decision support (CDS) into hospital electronic health records can lead to improvements in patient care and accelerate quality improvement and research initiatives. However, its design, development, and implementation can be a time-consuming and costly endeavor that may not be feasible for all hospital settings. ⋯ Overall, freestanding children's hospitals had the greatest breadth in CDS coverage across conditions and depth in CDS types within conditions. Future initiatives should examine the relationship between CDS availability and clinical outcomes as well as its relationship with hospitals' performance executing multicenter informatics projects, quality improvement collaboratives, and implementation science strategies.
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Pediatr Crit Care Me · Jul 2023
Multicenter StudyEarly Changes in Arterial Partial Pressure of Carbon Dioxide and Blood Pressure After Starting Extracorporeal Membrane Oxygenation in Children: Extracorporeal Life Support Organization Database Study of Neurologic Complications.
Neurologic complications in pediatric patients supported by extracorporeal membrane oxygenation (ECMO) are common and lead to morbidity and mortality; however, few modifiable factors are known. ⋯ In pediatric patients, a large decrease in Pa co2 and increase in MAP following ECMO initiation are both associated with neurologic complications. Future research focusing on managing these issues carefully soon after ECMO deployment can potentially help to reduce neurologic complications.
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Pediatric emergency care · Jul 2023
Multicenter StudyWhich Trauma Severity Scores Are Useful in Predicting Pediatric Mortality?
Trauma is the leading cause of death in children. Several trauma severity scores exist: the shock index (SI), age-adjusted SI (SIPA), reverse SI (rSI), and rSI multiplied by Glasgow Coma Score (rSIG). However, it is unknown which is the best predictor of clinical outcomes in children. Our goal was to determine the association between trauma severity scores and mortality in pediatric trauma. ⋯ Several trauma scores may help predict mortality in children with trauma, the best being rSIG. Introduction of these scores in algorithms for pediatric trauma evaluations can impact clinical decision-making.
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Multicenter Study
Patient and Process Outcomes Among Pediatric Patients Undergoing Appendectomy During the COVID-19 Pandemic - an International Retrospective Cohort study.
COVID-19 forced healthcare systems to make unprecedented changes in clinical care processes. The authors hypothesized that the COVID-19 pandemic adversely impacted timely access to care, perioperative processes, and clinical outcomes for pediatric patients undergoing primary appendectomy. ⋯ For children undergoing appendectomy, the COVID-19 pandemic did not significantly impact hospital length of stay.