National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Antibiotics (2)
- Antimicrobial Stewardship (2)
- Behavioral Health (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- (-) Children/Adolescents (13)
- (-) Critical Care (13)
- Diagnostic Safety and Quality (3)
- Education: Continuing Medical Education (1)
- Emergency Department (1)
- Evidence-Based Practice (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (1)
- Hospitals (1)
- Intensive Care Unit (ICU) (7)
- Medication (2)
- Mortality (1)
- Neurological Disorders (1)
- Outcomes (1)
- Patient-Centered Outcomes Research (1)
- Registries (2)
- Respiratory Conditions (3)
- Sepsis (1)
- Stroke (1)
- Trauma (1)
- Urinary Tract Infection (UTI) (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 13 of 13 Research Studies DisplayedLaverriere EK, Fiadjoe JE, McGowan N
A prospective observational study of video laryngoscopy-guided coaching in the pediatric intensive care unit.
The primary goal of this study was to evaluate whether implementation of video laryngoscopy-guided coaching for tracheal intubation in pediatric patients is feasible with a high level of compliance and associated with a reduction in adverse tracheal intubation-associated events. Findings showed that implementation of video laryngoscopy as a supervising device with standardized coaching language was feasible with a high level of adherence, yet was not associated with an increased occurrence of any adverse tracheal intubation-associated events and oxygen desaturation.
AHRQ-funded; HS024511; HS021583; HS022464.
Citation: Laverriere EK, Fiadjoe JE, McGowan N .
A prospective observational study of video laryngoscopy-guided coaching in the pediatric intensive care unit.
Paediatr Anaesth 2022 Sep;32(9):1015-23. doi: 10.1111/pan.14505..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Education: Continuing Medical Education
Ramesh S, Ayres B, Eyck PT
Impact of subspecialty consultations on diagnosis in the pediatric intensive care unit.
This retrospective study used chart reviews of critically ill children in the pediatric intensive care unit (PICU) to determine the impact of subspecialty consultations on diagnosis. The majority of patients (87 of 101) were provided subspecialty consultations at the request of the PICU clinician. The consultations were equally for diagnosis (65%) and treatment (66%). There was a change in diagnosis for 21% of patients with consultants from PICU admission to discharge, with 61% attributed to subspecialty input. Forty-five percent of patients with consultations had additional imaging and/or laboratory testing and 55% had a medication change and/or a procedure performed immediately after consultation.
AHRQ-funded; HS026965.
Citation: Ramesh S, Ayres B, Eyck PT .
Impact of subspecialty consultations on diagnosis in the pediatric intensive care unit.
Diagnosis 2022 Aug;9(3):379-84. doi: 10.1515/dx-2021-0137..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Diagnostic Safety and Quality
Woods-Hill CZ, Colantuoni EA, Koontz DW
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
The purpose of this AHRQ-funded prospective study was to assess the relationship between a 14-site PICU blood culture collaborative, the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative, and culture rates, antibiotic use, and patient outcomes. The researchers collected data from each participating PICU across the United States and from the Children’s Hospital Association Pediatric Health Information System. The main outcome was blood culture rates, with secondary outcomes including: broad-spectrum antibiotic use and PICU rates of central line-associated bloodstream infection (CLABSI), Clostridioides difficile infection, readmission, length of stay, sepsis, severe sepsis/septic shock, and mortality. The study found that the blood culture rate preimplementation across the 14 PICUs was 149.4 per 1000 patient days per month, and the rate postimplementation was 100.5 for a 33% relative reduction postimplementation. For those same periods, the rate of antibiotic use decreased from 506 days per 1000 patient-days per month preimplementation to 440 days per 1000 patient-days per month postimplementation, which reflects a 13% relative reduction. Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days per month, a 36% relative reduction. The variables of length of stay, readmission, sepsis, severe sepsis/septic shock, and mortality were similar before and after implementation. The researchers concluded that collaborative interventions can reduce blood culture and antibiotic use in the PICU.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Colantuoni EA, Koontz DW .
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
JAMA Pediatr 2022 Jul;176(7):690-98. doi: 10.1001/jamapediatrics.2022.1024..
Keywords: Children/Adolescents, Sepsis, Critical Care, Antibiotics, Medication, Diagnostic Safety and Quality, Antimicrobial Stewardship
Lindell RB, Fitzgerald JC, Rowan CM
The use and duration of preintubation respiratory support is associated with increased mortality in immunocompromised children with acute respiratory failure.
The purpose of this retrospective cohort study was to examine the relationship between preintubation respiratory support and outcomes in pediatric patients with acute respiratory failure and to evaluate the impact of immunocompromised (IC) diagnoses on outcomes. The study utilized data from the Virtual Pediatric Systems database which included 82 centers, and focused on patients intubated in the Pediatric Intensive Care Unit (PICU) ranging in age from 1 month old to 17 years of age who received invasive mechanical ventilation (IMV) for more than or equal to 24 hours. Of the 5,348 PICU intubations across 82 centers, high-flow nasal cannula (HFNC) or noninvasive positive-pressure ventilation (NIPPV) or both were used before intubation in 34% (1,825) of patients. Fifty percent of the patients had no IC diagnosis. The researchers found that exposure to HFNC was associated with greater odds of PICU mortality when compared with patients intubated without prior support. When analyzing subgroups of IC status, preintubation support was related to higher odds of PICU mortality in IC patients and HCT patients when compared with IC/ HCT patients intubated without prior respiratory support. A duration of HFNC/NIPPV of more than 6 hours was associated with increased mortality in IC HCT patients. Rates of preintubation HFNC/NIPPV use and PICU mortality varied between the 82 centers. The researchers concluded that greater duration of exposure to HFNC/NIPPV prior to IMV is associated with increased mortality in HCT patients, and preintubation exposure to HFNC and/or NIPPV in IC pediatric patients is associated with increased odds of PICU mortality, independent of the severity of the illness.
AHRQ-funded; HS024511.
Citation: Lindell RB, Fitzgerald JC, Rowan CM .
The use and duration of preintubation respiratory support is associated with increased mortality in immunocompromised children with acute respiratory failure.
Crit Care Med 2022 Jul;50(7):1127-37. doi: 10.1097/ccm.0000000000005535..
Keywords: Children/Adolescents, Respiratory Conditions, Mortality, Critical Care
Chiotos K, Fitzgerald JC, Hayes M
Improving vancomycin stewardship in critically ill children.
The purpose of this study was to describe a quality improvement intervention to reduce the use of vancomycin in a tertiary care Pediatric Intensive Care Unit. Over a period of 3 years, the researchers conducted 3 quality improvement (QI) interventions including 1) stakeholder education, 2) development of a consensus-based guideline for empiric vancomycin use, and 3) implementation of the guideline through clinical decision support. The study found that of 1276 episodes of suspected bacterial infection, a total of 19 cases of bacteremia (1.5%) due to organisms requiring vancomycin therapy were identified, including 6 MRSA bacteremias. Over the 3-year period of the QI project, overall vancomycin DOT per 1000 patient days in the PICU decreased from a baseline mean of 182 DOT per 1000 patient days to 109 DOT per 1000 patient days (a 40% reduction). The study concluded that the intervention reduced overall vancomycin use in the Pediatric Intensive Care Unit without evidence of harm.
AHRQ-funded; HS026393.
Citation: Chiotos K, Fitzgerald JC, Hayes M .
Improving vancomycin stewardship in critically ill children.
Pediatrics 2022 Apr;149(4):e2021052165. doi: 10.1542/peds.2021-052165..
Keywords: Children/Adolescents, Critical Care, Antimicrobial Stewardship, Antibiotics, Medication, Intensive Care Unit (ICU)
Capone CA, Emerson B, Sweberg T
Intubation practice and outcomes among pediatric emergency departments: a report from National Emergency Airway Registry for Children (NEAR4KIDS).
The purpose of this study was to describe Tracheal Intubation (TI) practice and outcomes in pediatric Emergency Departments as compared to those in intensive care units (ICUs) and use the resulting data to identify targets for quality improvement. The researchers analyzed consecutive TI encounters from pediatric EDs and ICUs in the National Emergency Airway Registry for Children (NEAR4KIDS) database from 2015 to 2018. The study found a total of 12,512 TIs in 51 pediatric/cardiac ICUs, and 756 TIs in 13 pediatric EDs and were reported. Proportion of TIs for shock (26% ED vs. 14% ICU), respiratory decompensation (52% vs. 64%), and neurologic deterioration (30% vs. 11%) also differed by location. Limited neck mobility was reported more often in the ED (16% vs. 6%). TIs in the ED were performed more often via video laryngoscopy (64% vs. 29%). Oxygen desaturation was less commonly reported in ED TIs (13.6%) than ICU TIs (17%). Among ED TIs, shock as an indication and limited mouth opening were independently associated with adverse TI-associated events (TIAEs). The study concluded that TI characteristics vary between pediatric EDs and ICUs, yet outcomes are similar.
AHRQ-funded; HS022464.
Citation: Capone CA, Emerson B, Sweberg T .
Intubation practice and outcomes among pediatric emergency departments: a report from National Emergency Airway Registry for Children (NEAR4KIDS).
Acad Emerg Med 2022 Apr;29(4):406-14. doi: 10.1111/acem.14431..
Keywords: Children/Adolescents, Emergency Department, Registries, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Critical Care, Intensive Care Unit (ICU)
Vivtcharenko VY, Ramesh S, Dukes K
Diagnosis documentation of critically ill children at admission to a PICU.
This study’s objective was to describe how pediatric critical care clinicians document patients' diagnoses at PICU admission. PICU admission notes for 96 unique patients were reviewed. Findings showed that most PICU admission notes documented a rationale for the primary diagnosis and expressed diagnostic uncertainty. Clinicians varied widely in how they organized diagnostic information, used contextual details to clarify the diagnosis, and expressed uncertainty. Recommendations included future work to determine how diagnosis narratives affect clinical decision-making, patient care, and outcomes.
AHRQ-funded; HS026965; HS022087.
Citation: Vivtcharenko VY, Ramesh S, Dukes K .
Diagnosis documentation of critically ill children at admission to a PICU.
Pediatr Crit Care Med 2022 Feb;23(2):99-108. doi: 10.1097/pcc.0000000000002812..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Diagnostic Safety and Quality
Williams CN, Piantino J, McEvoy C
The burden of pediatric neurocritical care in the United States.
This article attempts to quantify the burden of pediatric neurocritical care (PNCC) by developing national estimates of disease incidence, evaluating use of critical care interventions (CCI), and examining hospital outcomes. The Kids Inpatient Database (KID) was analyzed to evaluate cohorts with the following conditions: traumatic brain injury, neuro-infection, or inflammatory diseases; status epilepticus; stroke; hypoxic ischemic injury after cardiac arrest; or spinal cord injury.
AHRQ-funded; HS022981.
Citation: Williams CN, Piantino J, McEvoy C .
The burden of pediatric neurocritical care in the United States.
Pediatr Neurol 2018 Dec;89:31-38. doi: 10.1016/j.pediatrneurol.2018.07.013..
Keywords: Children/Adolescents, Critical Care, Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Neurological Disorders, Stroke, Trauma
Sobotka SA, Peters S, Pinto NP
Neurodevelopmental disorders in the PICU population.
Attention deficit hyperactivity disorder (ADHD), affecting 11% of children and adolescents, increases risk for injury and may predispose children to illness. However, the prevalence of ADHD and other developmental disorders in the pediatric intensive care unit (PICU) has not been previously studied. In this study, the investigators performed a single-center, prospective cohort study of children aged 6 to 12 years who were hospitalized in the PICU from May through August 2016.
AHRQ-funded; HS023007.
Citation: Sobotka SA, Peters S, Pinto NP .
Neurodevelopmental disorders in the PICU population.
Clin Pediatr 2018 Jul;57(8):913-19. doi: 10.1177/0009922817737080..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Behavioral Health
Kojima T, Harwayne-Gidansky I, Shenoi AN
Cricoid pressure during induction for tracheal intubation in critically ill children: a report from National Emergency Airway Registry for Children.
The objective of this retrospective cohort study was to evaluate the association between cricoid pressure use and the occurrence of regurgitation during tracheal intubation for critically ill children in pediatric intensive care unit (PICU). The investigators found that cricoid pressure during induction and mask ventilation before tracheal intubation in the current ICU practice was not associated with a lower regurgitation rate after adjusting for previously reported confounders.
AHRQ-funded; HS024511.
Citation: Kojima T, Harwayne-Gidansky I, Shenoi AN .
Cricoid pressure during induction for tracheal intubation in critically ill children: a report from National Emergency Airway Registry for Children.
Pediatr Crit Care Med 2018 Jun;19(6):528-37. doi: 10.1097/pcc.0000000000001531.
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Keywords: Children/Adolescents, Critical Care, Children/Adolescents, Registries, Respiratory Conditions
Kojima T, Laverriere EK, Owen EB
Clinical impact of external laryngeal manipulation during laryngoscopy on tracheal intubation success in critically ill children.
In this retrospective observational study, the objective was to evaluate the association between external laryngeal manipulation use and initial tracheal intubation attempt success in pediatric ICUs. The investigators found that external laryngeal manipulation during direct laryngoscopy was associated with lower initial tracheal intubation attempt success in critically ill children, even after adjusting for underlying differences in patient factors and provider levels. They asserted that the indiscriminate use of external laryngeal manipulation cannot be recommended.
AHRQ-funded; HS024511.
Citation: Kojima T, Laverriere EK, Owen EB .
Clinical impact of external laryngeal manipulation during laryngoscopy on tracheal intubation success in critically ill children.
Pediatr Crit Care Med 2018 Feb;19(2):106-14. doi: 10.1097/pcc.0000000000001373..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Children/Adolescents, Respiratory Conditions
Balamuth F, Weiss SL, Neuman MI
Pediatric severe sepsis in U.S. children's hospitals.
The objective of this study was to compare epidemiological trends in the prevalence, resource utilization, and mortality of pediatric patients with severe sepsis and septic shock. The researchers found that the prevalence of severe sepsis/septic shock has increased in the studied U.S. children’s hospitals between 2004 and 2012, whereas resource utilization and mortality have decreased over that time period.
AHRQ-funded; HS021114
Citation: Balamuth F, Weiss SL, Neuman MI .
Pediatric severe sepsis in U.S. children's hospitals.
Pediatr Crit Care Med. 2014 Nov;15(9):798-805. doi: 10.1097/pcc.0000000000000225..
Keywords: Hospitals, Children/Adolescents, Critical Care
Patrick SW, Kawai AT, Kleinman K
Health care-associated infections among critically ill children in the US, 2007-2012.
The researchers examined trends in central line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (VAP) incidence rates between 2007 and 2012 based on standardized surveillance data from pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs) in the United States. They found that incidence rates of CLABSIs and VAPs decreased among critically ill neonates and children during this period.
AHRQ-funded; HS018414.
Citation: Patrick SW, Kawai AT, Kleinman K .
Health care-associated infections among critically ill children in the US, 2007-2012.
Pediatrics 2014 Oct;134(4):705-12. doi: 10.1542/peds.2014-0613..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Urinary Tract Infection (UTI), Critical Care, Children/Adolescents, Healthcare-Associated Infections (HAIs)