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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (2)
- Behavioral Health (3)
- Care Management (1)
- (-) Children/Adolescents (21)
- COVID-19 (1)
- Dental and Oral Health (1)
- Diabetes (1)
- Diagnostic Safety and Quality (3)
- Disparities (1)
- (-) Emergency Department (21)
- Evidence-Based Practice (1)
- Guidelines (1)
- Healthcare Cost and Utilization Project (HCUP) (5)
- Healthcare Utilization (1)
- Health Insurance (1)
- Hospitalization (1)
- Hospitals (1)
- Imaging (4)
- Infectious Diseases (1)
- Injuries and Wounds (2)
- Medical Errors (1)
- Medication (3)
- Neurological Disorders (2)
- Opioids (2)
- Outcomes (1)
- Pain (1)
- Patient Safety (1)
- Practice Patterns (2)
- Racial and Ethnic Minorities (2)
- Risk (3)
- Rural Health (1)
- Sepsis (2)
- Teams (1)
- Trauma (2)
- Urban Health (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 21 of 21 Research Studies DisplayedGreenwald E, Olds E, Leonard J
Pediatric sepsis in community emergency care settings: guideline concordance and outcomes.
The authors sought to describe the rate of guideline-concordant care, and hypothesized that guideline-concordant care in community pediatric emergency care settings would be associated with decreased hospital length of stay (LOS). They found that guideline-concordant care was not associated with hospital LOS. The elements that drove overall concordance were timely recognition, vascular access, and timely antibiotics. Emergency care for pediatric sepsis in the community settings studied was concordant with guidelines in only 24% of the cases. They recommended future study to evaluate additional drivers of outcomes and ways to improve sepsis care in community emergency care settings.
AHRQ-funded; HS025696.
Citation: Greenwald E, Olds E, Leonard J .
Pediatric sepsis in community emergency care settings: guideline concordance and outcomes.
Pediatr Emerg Care 2021 Dec;37(12):e1571-e77. doi: 10.1097/pec.0000000000002120..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Guidelines, Evidence-Based Practice
Tremblay ES, Millington K, Monuteaux MC
Plasma β-Hydroxybutyrate for the diagnosis of diabetic ketoacidosis in the emergency department.
Diabetic ketoacidosis (DKA) is a common emergency department presentation of both new-onset and established diabetes mellitus (DM). β-Hydroxybutyrate (BOHB) provides a direct measure of the pathophysiologic derangement in DKA as compared with the nonspecific measurements of blood pH and bicarbonate. The objective of this study was to characterize the relationship between BOHB and DKA. The investigators concluded that β-Hydroxybutyrate accurately predicted DKA in children and adolescents. More importantly, because plasma BOHB is the ideal biochemical marker of DKA, BOHB may provide a more optimal definition of DKA for management decisions and treatment targets.
AHRQ-funded; HS000063.
Citation: Tremblay ES, Millington K, Monuteaux MC .
Plasma β-Hydroxybutyrate for the diagnosis of diabetic ketoacidosis in the emergency department.
Pediatr Emerg Care 2021 Dec;37(12):e1345-e50. doi: 10.1097/pec.0000000000002035..
Keywords: Children/Adolescents, Emergency Department, Diabetes, Diagnostic Safety and Quality
Hoffmann JA, Hall M, Lorenz D
Emergency department visits for suicidal ideation and self-harm in rural and urban youths.
The authors sought to compare emergency department (ED) visit rates for suicidal ideation and/or self-harm among youth by urban-rural location of residence. Data was taken from the Nationwide Emergency Department Sample. They found that, compared with youths living in urban areas, youths living in rural areas had higher ED visit rates for self-harm, including self-inflicted firearm injuries. The researchers recommended preventive approaches for self-harm based in community and ED settings in order to help address these differences.
AHRQ-funded; HS026385.
Citation: Hoffmann JA, Hall M, Lorenz D .
Emergency department visits for suicidal ideation and self-harm in rural and urban youths.
J Pediatr 2021 Nov;238:282-89.e1. doi: 10.1016/j.jpeds.2021.07.013..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Behavioral Health, Rural Health, Urban Health, Healthcare Utilization
Goyal MK, Drendel AL, Chamberlain JM
Racial/ethnic differences in ED opioid prescriptions for long bone fractures: trends over time.
The purpose of this study was to investigate whether racial and/or ethnic differences in provision of outpatient opioid prescriptions for children discharged from the ED with long bone fractures have decreased over time. Findings showed that, as provision of opioid prescriptions declined over time, previously marked racial and/or ethnic disparities in opioid
prescription rates at ED discharge decreased.
prescription rates at ED discharge decreased.
AHRQ-funded; HS020270.
Citation: Goyal MK, Drendel AL, Chamberlain JM .
Racial/ethnic differences in ED opioid prescriptions for long bone fractures: trends over time.
Pediatrics 2021 Nov;148(5):e2021052481. doi: 10.1542/peds.2021-052481..
Keywords: Children/Adolescents, Opioids, Emergency Department, Racial and Ethnic Minorities, Injuries and Wounds, Pain, Medication
Sosa T, Sitterding M, Dewan M
Optimizing situation awareness to reduce emergency transfers in hospitalized children.
Interventions to improve care team situation awareness (SA) are associated with reduced rates of unrecognized clinical deterioration in hospitalized children. By addressing themes from recent safety events and emerging corruptors to SA in their system, the investigators aimed to decrease emergency transfers (ETs) to the ICU by 50% over 10 months. The investigators concluded that an innovative, proactive, and reliable process to predict, prevent, and respond to clinical deterioration was associated with a nearly 70% reduction in ETs.
AHRQ-funded; HS026975.
Citation: Sosa T, Sitterding M, Dewan M .
Optimizing situation awareness to reduce emergency transfers in hospitalized children.
Pediatrics 2021 Oct;148(4). doi: 10.1542/peds.2020-034603..
Keywords: Children/Adolescents, Emergency Department, Teams
Hoffmann JA, Pergjika A, Konicek CE
Pharmacologic management of acute agitation in youth in the emergency department.
In this article, the authors reviewed the definition of agitation and pharmacologic management for youth with acute agitation, including common classes of medications, indications for use, and adverse effects. They also discussed the need to integrate the use of medications into a comprehensive strategy for agitation management that begins with proactive prevention of aggressive behavior, creation of a therapeutic treatment environment, and verbal de-escalation strategies.
AHRQ-funded; HS026385.
Citation: Hoffmann JA, Pergjika A, Konicek CE .
Pharmacologic management of acute agitation in youth in the emergency department.
Pediatr Emerg Care 2021 Aug;37(8):417-22. doi: 10.1097/pec.0000000000002510..
Keywords: Children/Adolescents, Emergency Department, Medication, Care Management
Michelson KA, Dart AH, Finkelstein JA KA, Dart AH, Finkelstein JA
Validation of an automated system for identifying complications of serious pediatric emergencies.
This study tested the effectiveness and feasibility of an automated system to identify complications of serious pediatric emergencies. This cross-sectional study analyzed patients <22 years old from 2012 to 2012 visiting a large pediatric emergency department. The patients had 1 of 14 serious conditions: appendicitis, bacterial meningitis, diabetic ketoacidosis (DKA), empyema, encephalitis, intussusception, mastoiditis, myocarditis, orbital cellulitis, ovarian torsion, sepsis, septic arthritis, stroke, or testicular torsion. The authors analyzed 1534 encounters and validated them using positive predictive values (PPVs) and negative predictive values (NPVs). Larger PPVs for complications were observed for DKA, empyema, encephalitis, ovarian torsion, and septic arthritis, and a lower NPV was observed in stroke.
AHRQ-funded; HS026503.
Citation: Michelson KA, Dart AH, Finkelstein JA KA, Dart AH, Finkelstein JA .
Validation of an automated system for identifying complications of serious pediatric emergencies.
Hosp Pediatr 2021 Aug;11(8):864-78. doi: 10.1542/hpeds.2020-005792..
Keywords: Children/Adolescents, Emergency Department
Choi KR, Martinez-Hollingsworth A, Mead M
Adolescent psychiatric emergencies precipitated by the COVID-19 pandemic.
The purpose of this retrospective case series was to describe adolescent psychiatric emergencies precipitated by the coronavirus disease 2019 (COVID-19) pandemic. Findings showed that COVID-19-precipitated admissions were 24% of total admissions from March 15 to May 31, 2020; however, total admissions during this time period were reduced from the same time period in prior years. The COVID-19 pandemic and corresponding shelter-in-place orders may precipitate psychiatric emergencies among adolescents both with and without existing mental health disorders.
AHRQ-funded; HS026407.
Citation: Choi KR, Martinez-Hollingsworth A, Mead M .
Adolescent psychiatric emergencies precipitated by the COVID-19 pandemic.
J Psychosoc Nurs Ment Health Serv 2021 Jul;59(7):17-21. doi: 10.3928/02793695-20201203-05..
Keywords: Children/Adolescents, COVID-19, Behavioral Health, Emergency Department
Zachrison KS, Boggs KM, Gao j
Patient insurance status is associated with care received after transfer among pediatric patients in the emergency department.
The objective of this study was to determine whether frequency of interfacility transfer varied by insurance status among pediatric emergency department (ED) patients. Secondarily, the investigators tested for an association between insurance status and odds of transfer with discharge from the second ED without observation or admission. The investigators concluded that among ED-to-ED transfers, pediatric patients with public or without insurance were more often kept for observation or admission at the second hospital after transfer.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Boggs KM, Gao j .
Patient insurance status is associated with care received after transfer among pediatric patients in the emergency department.
Acad Pediatr 2021 Jul;21(5):877-84. doi: 10.1016/j.acap.2020.11.010..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Health Insurance, Emergency Department
Worsham CM, Woo J, Jena AB
Adverse events and emergency department opioid prescriptions in adolescents.
Understanding the risks associated with opioid prescription in adolescents is critical for informing opioid policy, but the risks are challenging to quantify given the lack of randomized trial data. Using a regression discontinuity design, the investigators exploited a discontinuous increase in opioid prescribing in the emergency department (ED) when adolescents transitioned from "child" to "adult" at age eighteen to estimate the effect of an ED opioid prescription on subsequent opioid-related adverse events.
AHRQ-funded; HS026753.
Citation: Worsham CM, Woo J, Jena AB .
Adverse events and emergency department opioid prescriptions in adolescents.
Health Aff 2021 Jun;40(6):970-78. doi: 10.1377/hlthaff.2020.01762..
Keywords: Children/Adolescents, Emergency Department, Opioids, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Practice Patterns
Piantino JA, Lin A, Luther M
Simultaneous heart rate variability and electroencephalographic monitoring in children in the emergency department.
This study’s objective was to determine the clinical value of using changes in heart rate variability (HRV) and electroencephalographic (EEG) background in children with acute trauma seen in the Emergency Department (ED) as early predictors of outcome. A novel wireless monitoring device was piloted in 17 patients with 15 patients having EEG data rated as appropriate for clinical interpretation. This was compared to EEG and HRV data successfully collected in 167 subjects. Results showed recording early HRV and EEG is feasible in children with acute injury. This new tool may offer an early, non-invasive marker for injury stratification and prognosis in children.
AHRQ-funded; HS022981.
Citation: Piantino JA, Lin A, Luther M .
Simultaneous heart rate variability and electroencephalographic monitoring in children in the emergency department.
J Child Adolesc Trauma 2021 Jun;14(2):165-75. doi: 10.1007/s40653-020-00313-1..
Keywords: Children/Adolescents, Emergency Department, Trauma, Outcomes
Cifra CL, Westlund E, Ten Eyck P
An estimate of missed pediatric sepsis in the emergency department.
AHRQ-funded; HS025753.
Citation: Cifra CL, Westlund E, Ten Eyck P .
An estimate of missed pediatric sepsis in the emergency department.
Diagnosis 2021;8(2):193-98. doi: 10.1515/dx-2020-0023..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Diagnostic Safety and Quality, Medical Errors, Risk
Lin CY, Xie J, Freedman SB
Predicting adverse outcomes for Shiga toxin-producing Escherichia coli infections in emergency departments.
Investigators assessed the performance of a hemolytic uremic syndrome (HUS) severity score among children with Shiga toxin-producing Escherichia coli (STEC) infections and HUS by stratifying them according to their risk of adverse events. They found that the HUS severity score was able to discriminate between high- and low-risk children less than 5 years old with STEC-associated HUS at a statistically acceptable level; however, it did not appear to provide clinical benefit at a meaningful risk threshold.
AHRQ-funded; HS026503.
Citation: Lin CY, Xie J, Freedman SB .
Predicting adverse outcomes for Shiga toxin-producing Escherichia coli infections in emergency departments.
J Pediatr 2021 May;232:200-06.e4. doi: 10.1016/j.jpeds.2020.12.077..
Keywords: Children/Adolescents, Infectious Diseases, Emergency Department, Risk
Nash KA, Zima BT, Rothenberg C
Prolonged emergency department length of stay for US pediatric mental health visits (2005-2015).
Children seeking care in the emergency department (ED) for mental health conditions are at risk for prolonged length of stay (LOS). A more contemporary description of trends and visit characteristics associated with prolonged ED LOS at the national level is lacking in the literature. The objectives of this study were to (1) compare LOS trends for pediatric mental health versus non-mental health ED visits and (2) explore patient-level characteristics associated with prolonged LOS for mental health ED visits.
AHRQ-funded; HS026385.
Citation: Nash KA, Zima BT, Rothenberg C .
Prolonged emergency department length of stay for US pediatric mental health visits (2005-2015).
Pediatrics 2021 May;147(5). doi: 10.1542/peds.2020-030692..
Keywords: Children/Adolescents, Emergency Department, Behavioral Health
Daymont C, Balamuth F, Scott HF
Elevated heart rate and risk of revisit with admission in pediatric emergency patients.
This study examines whether emergency department (ED) heart rate (HR) values can identify children at elevated risk of ED revisit with admission. The authors performed a retrospective cohort study of children ages 0-18 years discharged from a tertiary-care pediatric ED from 2013 to 2014. They created percentile curves for the last recorded HR for age using data from calendar year 2013 and used receiver operating characteristic (ROC) curves to characterize the performance of the percentiles for predicting ED revisit with admission within 72 hours. They evaluated 183,433 eligible ED visits and found that the last recorded HR for age had poor discrimination for predicting revisit with admission.
AHRQ-funded; HS023827.
Citation: Daymont C, Balamuth F, Scott HF .
Elevated heart rate and risk of revisit with admission in pediatric emergency patients.
Pediatr Emerg Care 2021 Apr;37(4):e185-e91. doi: 10.1097/pec.0000000000001552..
Keywords: Children/Adolescents, Emergency Department, Risk, Hospitalization
Michelson KA, Dart AH, Bachur RG
Measuring complications of serious pediatric emergencies using ICD-10.
The purpose of this study was to create definitions for complications for 16 serious pediatric conditions using the International Classification of Diseases, 10th Revision, Clinical Modification or Procedure Coding System (ICD-10-CM/PCS), and to assess whether complication rates are similar to those measured with ICD-9-CM/PCS. The investigators concluded that for most conditions, incidences and complication rates were similar before and after the transition to ICD-10-CM/PCS codes, suggesting their system identified complications of conditions in administrative data similarly using ICD-9-CM/PCS and ICD-10-CM/PCS codes.
AHRQ-funded; HS026503.
Citation: Michelson KA, Dart AH, Bachur RG .
Measuring complications of serious pediatric emergencies using ICD-10.
Health Serv Res 2021 Apr;56(2):225-34. doi: 10.1111/1475-6773.13615..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Adverse Events
Cavallaro SC, Monuteaux MC, Chaudhari PP
Use of neuroimaging for children with seizure in general and pediatric emergency departments.
Investigators sought to compare rates of head computed tomography (CT) scans for pediatric seizure between general and pediatric emergency departments (EDs). Subjects were patients 21 years of age or less who presented to an ED with a chief complaint or diagnosis of seizure. They investigators found that general EDs obtained CT scans of the head more often in patients with epilepsy, without fever, and without trauma. They concluded that children with seizure were more likely to undergo CT scans of the head at general EDs compared with pediatric EDs.
AHRQ-funded; HS026503.
Citation: Cavallaro SC, Monuteaux MC, Chaudhari PP .
Use of neuroimaging for children with seizure in general and pediatric emergency departments.
J Emerg Med 2021 Apr;60(4):478-84. doi: 10.1016/j.jemermed.2020.10.044..
Keywords: Children/Adolescents, Emergency Department, Imaging, Neurological Disorders
Azadani EN, Townsend J, Peng J
The association between traumatic dental and brain injuries in American children.
This study examined the association between dento-alveolar trauma (DAT) and traumatic brain injuries (TBIs) among children ages 0-18 years. The Nationwide Emergency Department Sample (NEDS), an HCUP dataset, was analyzed using ICD-9-CM codes for the 2010-2014 NEDS data. Out of 6,281,658 emergency department (ED) visits, DAT was recorded in 93,408 (1.5%) visits and TBI was recorded in 996,334 (15.9%) visits. Of the DAT-positive encounters, 7.5% had codes associated with TBI. Patients with DAT had 0.20 odds of having TBI compared with patients who did not DAT when all confounding variables were kept constant. Multiple injuries, being involved in motor vehicle crashes, and injuries due to assault were associated with higher odds of concomitant TBI in patients who sustained DAT.
AHRQ-funded; HS24263.
Citation: Azadani EN, Townsend J, Peng J .
The association between traumatic dental and brain injuries in American children.
Dent Traumatol 2021 Feb;37(1):114-22. doi: 10.1111/edt.12611..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Trauma, Neurological Disorders, Dental and Oral Health
Marin JR, Rodean J, Hall M
Racial and ethnic differences in emergency department diagnostic imaging at US children's hospitals, 2016-2019.
Researchers evaluated racial and ethnic differences in the performance of common ED imaging studies and examined patterns across diagnoses. In this study, which evaluated visits by nonhospitalized patients younger than 18 years in 44 US children's hospital EDs, they found that non-Hispanic Black and Hispanic children were less likely to receive diagnostic imaging during ED visits compared with non-Hispanic White children. They recommended further investigation to understand and mitigate these potential disparities in health care delivery and to evaluate the effect of these differential imaging patterns on patient outcomes.
AHRQ-funded; HS026006.
Citation: Marin JR, Rodean J, Hall M .
Racial and ethnic differences in emergency department diagnostic imaging at US children's hospitals, 2016-2019.
JAMA Netw Open 2021 Jan 4(1):e2033710. doi: 10.1001/jamanetworkopen.2020.33710..
Keywords: Children/Adolescents, Hospitals, Emergency Department, Imaging, Racial and Ethnic Minorities, Disparities, Diagnostic Safety and Quality
Henry MK, French B, Feudtner C
Cervical spine imaging and injuries in young children with non-motor vehicle crash-associated traumatic brain injury.
Researchers evaluated cervical magnetic resonance imaging and computed tomography practices and cervical spine injuries among a stratified random sample of young children with non-motor vehicle crash-associated traumatic brain injury (TBI). They found that abusive head trauma victims appeared to be at increased risk of cervical injuries. They recommended prospective studies to define the risk of cervical injury in children with TBI concerning for abusive head trauma and to inform development of imaging guidelines.
AHRQ-funded; HS024194.
Citation: Henry MK, French B, Feudtner C .
Cervical spine imaging and injuries in young children with non-motor vehicle crash-associated traumatic brain injury.
Pediatr Emerg Care 2021 Jan;37(1):e1-e6. doi: 10.1097/pec.0000000000001455..
Keywords: Children/Adolescents, Imaging, Injuries and Wounds, Injuries and Wounds, Emergency Department
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