National Healthcare Quality and Disparities Report
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- Adverse Events (1)
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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 20 of 20 Research Studies DisplayedSonik RA, Coleman-Jensen A, Parish SL
Household food insufficiency, health status and emergency healthcare utilisation among children with and without special healthcare needs.
The purpose of this study was to compare exposure to household food insufficiency and the relationship between household food insufficiency and both health status and emergency healthcare utilization among children with and without special healthcare needs (SHCN). The investigators concluded that compared with other children, children with SHCN have an elevated risk of exposure to household food insufficiency and experiencing greater reductions in health status when exposed.
AHRQ-funded; HS026317.
Citation: Sonik RA, Coleman-Jensen A, Parish SL .
Household food insufficiency, health status and emergency healthcare utilisation among children with and without special healthcare needs.
Public Health Nutr 2020 Dec;23(17):3204-10. doi: 10.1017/s1368980020000361..
Keywords: Children/Adolescents, Nutrition, Health Status, Emergency Department, Public Health
Harder VS, Shaw JS, McCulloch CE
Statewide asthma learning collaborative participation and asthma-related emergency department use.
This study looked at outcomes from participation of pediatric practices in a quality improvement (QI) collaborative to decrease asthma-related emergency department (ED) visits. A statewide network of practices participated in the collaborative from 2015 to 2016. Asthma-related ED visit rates per 100 child-years for children ages 3 to 21 was evaluated using the state’s all-payer claims databases. The authors found that in the postintervention year (2017) participating practices’ ED visit rate decreased by 5.8 per 100 child-years, compared to an increase of 1.8 per 100 child-years in non-participating practices. There were no statistically significant differences in asthma-related ED visit rates during 2016, which indicated that it took some time for QI elements to be successfully implemented in pediatric practices.
AHRQ-funded; HS025297.
Citation: Harder VS, Shaw JS, McCulloch CE .
Statewide asthma learning collaborative participation and asthma-related emergency department use.
Pediatrics 2020 Dec;146(6):e20200213. doi: 10.1542/peds.2020-0213..
Keywords: Children/Adolescents, Asthma, Emergency Department, Quality Improvement, Quality of Care, Primary Care, Guidelines
Michelson KA, Hudgins JD, Burke LG
Trends in severe pediatric emergency conditions in a national cohort, 2008 to 2014.
The objective of this study was to determine the incidence and recent trends in serious pediatric emergency conditions. Data from the Nationwide Emergency Department Sample 2008-2014 was used, and included patients less than18 years of age with a serious condition. Findings showed that the most common serious condition in children presenting to United States emergency departments was serious respiratory disease, while anaphylaxis was the fastest increasing serious condition.
AHRQ-funded; T32 HS000063.
Citation: Michelson KA, Hudgins JD, Burke LG .
Trends in severe pediatric emergency conditions in a national cohort, 2008 to 2014.
Pediatr Emerg Care 2020 Nov;36(11):e620-e21. doi: 10.1097/pec.0000000000001409..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department
Slatnick LR, Thornhill D, Deakyne Davies
Disseminated intravascular coagulation is an independent predictor of adverse outcomes in children in the emergency department with suspected sepsis.
The purpose of this study was to evaluate the impact of early disseminated intravascular coagulation (DIC) on illness severity in children using a database of emergency department ED encounters for children with suspected sepsis, in view of similar associations in adults. The investigators concluded that a DIC score of ≥3 was an independent predictor for both vasopressor use and mortality in this pediatric cohort, distinct from the adult overt DIC score cutoff of ≥5.
AHRQ-funded; HS025696.
Citation: Slatnick LR, Thornhill D, Deakyne Davies .
Disseminated intravascular coagulation is an independent predictor of adverse outcomes in children in the emergency department with suspected sepsis.
J Pediatr 2020 Oct;225:198-206.e2. doi: 10.1016/j.jpeds.2020.06.022..
Keywords: Children/Adolescents, Emergency Department, Sepsis, Adverse Events, Mortality, Patient Safety, Outcomes
Ramgopal S, Aronson PL, Marin JR
United States' emergency department visits for fever by young children 2007-2017.
The authors estimated rates of emergency department (ED) visits for fever by children less than 2 years of age and evaluated frequencies of testing and treatment during these visits. They found that, given existing guidelines, blood and urine culture performance was low for infants up to 90 days old. For children 91 days up to 2 years, rates of radiography and antibiotic use were higher in general EDs compared to pediatric EDs. They concluded that their findings suggest opportunities to improve care among febrile young children in the ED.
AHRQ-funded; HS026006.
Citation: Ramgopal S, Aronson PL, Marin JR .
United States' emergency department visits for fever by young children 2007-2017.
West J Emerg Med 2020 Oct 27;21(6):146-51. doi: 10.5811/westjem.2020.8.47455..
Keywords: Children/Adolescents, Emergency Department, Healthcare Utilization
Drendel AL, Brousseau DC, Casper TC
Opioid prescription patterns at emergency department discharge for children with fractures.
The authors sought to measure the variability in discharge opioid prescription practices for children discharged from the emergency department (ED) with a long-bone fracture. They found that, for children with a long-bone fracture, discharge opioid prescription varied widely by ED site of care. In addition, black patients, Hispanic patients, and patients with government insurance were less likely to be prescribed opioids. This variability in opioid prescribing was not accounted for by patient- or injury-related factors that are associated with increased pain.
AHRQ-funded; HS020270.
Citation: Drendel AL, Brousseau DC, Casper TC .
Opioid prescription patterns at emergency department discharge for children with fractures.
Pain Med 2020 Sep;21(9):1947-54. doi: 10.1093/pm/pnz348..
Keywords: Children/Adolescents, Opioids, Medication, Emergency Department, Injuries and Wounds, Practice Patterns
Cotter JM, Tyler A, Reese J
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
This study looked at pediatric emergency department (ED) inpatient use of dexamethasone versus prednisone by providers for asthma treatment. A survey was distributed to providers who care for inpatient asthmatics. Ninety-two providers completed the survey. When patients received dexamethasone in the ED, 44% continued dexamethasone, 14% switched to prednisone, 2% stopped steroid use, and 40% said it depended on the circumstances. Hospitalists were significantly more likely to continue dexamethasone than pulmonologists (61% versus 15%). Switching to prednisone included factors such as severity of exacerbation (73%) and asthma history (47%). Just over half of providers (5f1%) felt uncomfortable using dexamethasone because of “minimal data to support [its] use inpatient.”
AHRQ-funded; HS026512.
Citation: Cotter JM, Tyler A, Reese J .
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
J Asthma 2020 Sep;57(9):942-48. doi: 10.1080/02770903.2019.1622713..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Medication, Inpatient Care, Care Management, Hospitalization, Emergency Department, Practice Patterns, Provider: Physician, Provider
Marin JR, Rodean J, Hall M
Trends in use of advanced imaging in pediatric emergency departments, 2009-2018.
This study looked at trends in advanced imaging use in pediatric emergency departments (ED) from 2009 to 2018. This cross-sectional study assessed 26,082,062 ED visits by children younger than 18 years from the Pediatric Health Information System administrative database. These visits were made by 9,868,406 children (mean [SD] age, 5.59 [5.15] years; 13,842,567 [53.1%] male; 9,273,181 [35.6%] non-Hispanic white) to 32 US pediatric EDs during the 10-year study period. Advanced imaging trends looked at were for computed tomography (CT), ultrasonography, and magnetic resonance imaging (MRI). Trends in ED length of stay after imaging was also examined. ED encounters increased from 6.4% in 2009 to 8.7% in 2018. There were increases for ultrasonography and MRIs, but rates decreased slightly for CT. Increased use of ultrasonography were for abdominal pain and appendectomy, and MRI for ventricular shunt procedures. The largest decreases in CT rates were for concussion, appendectomy, ventricular shunt procedures, and headaches.
AHRQ-funded; HS026006.
Citation: Marin JR, Rodean J, Hall M .
Trends in use of advanced imaging in pediatric emergency departments, 2009-2018.
JAMA Pediatr 2020 Sep;174(9):e202209. doi: 10.1001/jamapediatrics.2020.2209..
Keywords: Children/Adolescents, Emergency Department, Imaging
Kaiser SV, Johnson MD, Walls TA
Pathways to improve pediatric asthma care: a multisite, national study of emergency department asthma pathway implementation.
This quality improvement study’s aim was to determine the effects of pediatric asthma pathway implementation in a diverse, national sample of emergency departments (EDs). Desired outcomes included systemic corticosteroid administration within 60 minutes (primary), assessment of severity at ED triage, chest radiograph use, hospital admission or transfer for higher level of care, and ED length of stay. Charts were reviewed each month by EDs for children ages 2-17 years with a primary diagnosis of asthma. A total of 83 EDs were enrolled, with 37 of them children’s hospitals, and 46 community hospitals. Seventy-three percent completed the study (n = 22,963). There was a significant increase in systematic corticosteroid administration within 60 minutes of arrival as well as increased odds of severity assessment at triage and decreased rate of change in odds of hospital admission/transfer. Chest radiograph or ED length of stay was not associated with pathway implementation.
AHRQ-funded; HS024592.
Citation: Kaiser SV, Johnson MD, Walls TA .
Pathways to improve pediatric asthma care: a multisite, national study of emergency department asthma pathway implementation.
J Pediatr 2020 Aug;223:100-07.e2. doi: 10.1016/j.jpeds.2020.02.080..
Keywords: Children/Adolescents, Emergency Department, Asthma, Quality Improvement, Quality of Care, Care Management, Healthcare Delivery, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Mueller EL, Jacob SA, Cochrane AR
Variation in hospital admission from the emergency department for children with cancer: a pediatric health information system study.
Children with cancer experience a wide range of conditions that require urgent evaluation in the emergency department (ED), yet variation in admission rates is poorly documented. In this study, the investigators performed a retrospective cohort study using the Pediatric Health Information System of ED encounters by children with cancer between July 2012 and June 2015. They concluded that the percentage of children with cancer admitted through the ED varied widely by institution and diagnosis.
AHRQ-funded; HS026390.
Citation: Mueller EL, Jacob SA, Cochrane AR .
Variation in hospital admission from the emergency department for children with cancer: a pediatric health information system study.
Pediatr Blood Cancer 2020 Jun;67(6):e28140. doi: 10.1002/pbc.28140..
Keywords: Children/Adolescents, Cancer, Emergency Department, Hospitalization
Jacob SA, Mueller EL, Cochrane AR
Variation in hospital admission of sickle cell patients from the emergency department using the pediatric health information system.
Investigators sought to determine the variation seen in hospitalizations for the top complaints for ED visits for children with sickle cell disease (SCD) nationally. Using data from the Pediatric Health Information Systems (PHIS) Database, they found that pain and fever were the most common primary diagnoses for children with SCD who seek acute care; while significant variation in hospitalization exists, it is not associated with day of the week. They recommend further studies to elucidate patient- and hospital-level factors that influence admission variation.
AHRQ-funded; HS026390.
Citation: Jacob SA, Mueller EL, Cochrane AR .
Variation in hospital admission of sickle cell patients from the emergency department using the pediatric health information system.
Pediatr Blood Cancer 2020 Jun;67(6):e28067. Epub ahead of print. doi: 10.1002/pbc.28067..
Keywords: Sickle Cell Disease, Emergency Department, Children/Adolescents, Hospitalization, Hospitals
Kovalerchik O, Powers E, Holland ML
Differences in frequency of visits to pediatric primary care practices and emergency departments by body mass index.
The purpose of this retrospective study was to examine differences in utilization across health care settings among children by body mass index (BMI) categories to help identify opportunities for interventions. The authors concluded that the children's BMI categories were associated with health care utilization, specifically primary care visits, ED visits, and hospitalizations.
AHRQ-funded; HS024332.
Citation: Kovalerchik O, Powers E, Holland ML .
Differences in frequency of visits to pediatric primary care practices and emergency departments by body mass index.
Acad Pediatr 2020 May-Jun;20(4):532-39. doi: 10.1016/j.acap.2019.12.011..
Keywords: Children/Adolescents, Primary Care, Emergency Department, Obesity, Healthcare Utilization
Johnson MD, Zorc JJ, Nelson DS
Intravenous magnesium in asthma pharmacotherapy: variability in use in the PECARN Registry.
Researchers examined the use, efficacy, and safety of intravenous magnesium sulfate (IVMg) in children with asthma whose emergency department (ED) management is recorded in the Pediatric Emergency Care Applied Research Network (PECARN) Registry. They found that, in PECARN Registry EDs, administration of IVMg occurred late in ED treatment, for a minority of the children likely to benefit, with variation between sites, which suggested the current clinical role for IVMg in preventing hospitalization was limited. Discharge after IVMg administration would likely be safe. They recommended further research to assess the efficacy and safety of early IVMg administration.
AHRQ-funded; HS020270.
Citation: Johnson MD, Zorc JJ, Nelson DS .
Intravenous magnesium in asthma pharmacotherapy: variability in use in the PECARN Registry.
J Pediatr 2020 May;220:165-74.e2. doi: 10.1016/j.jpeds.2020.01.062..
Keywords: Children/Adolescents, Asthma, Medication, Emergency Department, Registries, Treatments, Patient Safety, Medication: Safety
Balmaks R, Whitfill TM, Ziemele B
Pediatric readiness in the emergency department and its association with patient outcomes in critical care: a prospective cohort study.
The purpose of this study was to assess the quality of pediatric acute care and pediatric readiness and to determine their association with patient outcomes using a patient registry. Studying all Latvian Emergency Departments and the national PICU, researchers’ findings showed that a higher weighted pediatric readiness score was associated significantly with lower length of stay in both the PICU and hospital and lower 6-month mortality. Pediatric readiness in the emergency department was associated with patient outcomes in this population of pediatric patients transferred to the national PICU.
AHRQ-funded; HS020286.
Citation: Balmaks R, Whitfill TM, Ziemele B .
Pediatric readiness in the emergency department and its association with patient outcomes in critical care: a prospective cohort study.
Pediatr Crit Care Med 2020 May;21(5):e213-e20. doi: 10.1097/pcc.0000000000002255..
Keywords: Children/Adolescents, Emergency Department, Critical Care, Intensive Care Unit (ICU), Outcomes
Marcin JP, Romano PS, Dayal P
Provider-level and hospital-level factors and process measures of quality care delivered in pediatric emergency departments.
The objective of this study was to determine whether process measures of quality of care delivered to patients receiving care in children's hospital emergency departments were associated with physician-level or hospital-level factors. Subjects were children under 18 years old who presented to any of the 12 emergency departments that participated in the Pediatric Emergency Care Applied Research Network (PECARN).he researchers found that process measures of quality of care delivered to children was higher among patients treated at freestanding children's hospitals but lower among patients treated at higher volume emergency departments.
AHRQ-funded; HS019712.
Citation: Marcin JP, Romano PS, Dayal P .
Provider-level and hospital-level factors and process measures of quality care delivered in pediatric emergency departments.
Acad Pediatr 2020 May-Jun;20(4):524-31. doi: 10.1016/j.acap.2019.11.007..
Keywords: Children/Adolescents, Emergency Department, Hospitals, Quality Measures, Quality of Care
Goyal MK, Johnson TJ, Chamberlain JM
Racial and ethnic differences in emergency department pain management of children with fractures.
Researchers tested the hypotheses that minority children with long-bone fractures are less likely to receive analgesics, to receive opioid analgesics, and to achieve pain reduction. Using data from the Pediatric Emergency Care Applied Research Network Registry, they found that there are differences in process and outcome measures by race and ethnicity in the emergency department management of pain among children with long-bone fractures. Although minority children are more likely to receive analgesics and achieve reduction in pain, they are less likely to receive opioids and achieve optimal pain reduction.
AHRQ-funded; HS020270.
Citation: Goyal MK, Johnson TJ, Chamberlain JM .
Racial and ethnic differences in emergency department pain management of children with fractures.
Pediatrics 2020 May;145(5):e20193370. doi: 10.1542/peds.2019-3370..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Emergency Department, Pain, Injuries and Wounds, Medication, Opioids, Disparities
Cushing AM, Bucholz E, Michelson KA
Trends in regionalization of emergency care for common pediatric conditions.
This study examined trends in regionalization of emergency care for common pediatric conditions. The authors sought to determine how the likelihood of definitive care has changed for 3 common conditions: asthma, croup, and gastroenteritis. They used the National Emergency Department Sample Database to study children from 2008 to 2016 who presented to emergency departments with those primary diagnoses, excluding critically ill patients. Researchers conducted analyses by stratification of annual emergency department pediatric volume categorized by quartiles. Referral rates increased for all conditions in all volume quartiles, with referral rates greatest in the lowest pediatric volume quartile.
AHRQ-funded; HS026503.
Citation: Cushing AM, Bucholz E, Michelson KA .
Trends in regionalization of emergency care for common pediatric conditions.
Pediatrics 2020 Apr;145(4). doi: 10.1542/peds.2019-2989..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Asthma, Respiratory Conditions, Digestive Disease and Health, Healthcare Delivery
Scott HF, Colborn KL, Sevick CJ
Development and validation of a predictive model of the risk of pediatric septic shock using data known at the time of hospital arrival.
The purpose of this observational cohort study was to derive and validate a model of risk of septic shock among children with suspected sepsis, using data known in the electronic health record at hospital arrival. The investigators concluded that their model estimated the risk of septic shock in children at hospital arrival earlier than existing models. They indicate it leveraged the predictive value of routine electronic health record data through a modern predictive algorithm and suggest it has the potential to enhance clinical risk stratification in the critical moments before deterioration.
AHRQ-funded; HS025696.
Citation: Scott HF, Colborn KL, Sevick CJ .
Development and validation of a predictive model of the risk of pediatric septic shock using data known at the time of hospital arrival.
J Pediatr 2020 Feb;217:145-51.e6. doi: 10.1016/j.jpeds.2019.09.079..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Hospitals, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Michelson KA, Nigrovic LE, Nagler J
Research interest in pediatric emergency medicine fellows.
The authors sought to determine the prevalence and determinants of interest in research careers among pediatric emergency medicine (PEM) fellows. They performed an electronically distributed national survey of current PEM fellows, assessing demographics, barriers to successful research, and beliefs about research using 4-point ordinal scales. The authors found that most fellows expect to devote a minority of their career to clinical research. Enthusiasm about research was strongly correlated with career research interest.
AHRQ-funded; HS000063.
Citation: Michelson KA, Nigrovic LE, Nagler J .
Research interest in pediatric emergency medicine fellows.
Pediatr Emerg Care 2020 Feb;36(2):e38-e42. doi: 10.1097/pec.0000000000001085..
Keywords: Emergency Department, Children/Adolescents, Health Services Research (HSR), Provider: Physician, Provider, Education: Continuing Medical Education
Johnson EK, Graham DA, Chow JS
Nationwide emergency department imaging practices for pediatric urolithiasis: room for improvement.
The researchers describe the national use of computed tomography (CT) versus ultrasound imaging for pediatric patients seen at emergency departments (EDs) for suspected urolithiasis (SU) during the period 2006-2010. Use of CT was much higher than use of ultrasound, although it dropped off after 2007. Lowest CT use was seen at EDs that care for more children.
AHRQ-funded; HS019485
Citation: Johnson EK, Graham DA, Chow JS .
Nationwide emergency department imaging practices for pediatric urolithiasis: room for improvement.
J Urol. 2014 Jul;192(1):200-6. doi: 10.1016/j.juro.2014.01.028..
Keywords: Children/Adolescents, Emergency Department, Healthcare Cost and Utilization Project (HCUP), Imaging, Children/Adolescents, Practice Patterns