National Healthcare Quality and Disparities Report
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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 18 of 18 Research Studies DisplayedLindell 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
Bogetz JF, Revette A, Rosenberg AR
"I could never prepare for something like the death of my own child": parental perspectives on preparedness at end of life for children with complex chronic conditions.
This study’s goal was to elucidate aspects important to preparedness at end of life (EOL) among bereaved parents of children with complex chronic conditions (CCCs). Participants answered 21 open-response queries on communication, decision-making, and EOL experiences as part of the Survey of Caring for Children with CCCs. Findings showed that most bereaved parents of children with CCCs described feeling unprepared for their child's EOL, despite palliative care and advance care planning, suggesting preparedness is a nuanced concept beyond "readiness." Recommendations included more research to identify supportive elements among parents facing their child's EOL.
AHRQ-funded; HS022986.
Citation: Bogetz JF, Revette A, Rosenberg AR .
"I could never prepare for something like the death of my own child": parental perspectives on preparedness at end of life for children with complex chronic conditions.
J Pain Symptom Manage 2020 Dec;60(6):1154-62.e1. doi: 10.1016/j.jpainsymman.2020.06.035..
Keywords: Children/Adolescents, Caregiving, Mortality, Chronic Conditions, Palliative Care
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
Chaiyachati BH, Wood JN, Mitra N
All-cause mortality among children in the US foster care system, 2003-2016.
This letter provides data from a cross-sectional analysis of the Adoption and Foster Care Analysis and Reporting System on mortality rates among children in the US foster care system compared to the general population. The rate was found to be significantly higher for children in foster care (35.4 deaths per 100,000 person-years vs 25.0 for the general population). The highest mortality rates were among African-American children at 43.8 deaths per 100,000 person-years. Older children ages 15-18 had the highest mortality rate per years. Two major limitations of the analysis are that children in foster care are unable to be excluded from the Centers for Disease Control and Prevention data file, and more deaths in foster care were excluded relative to person-years in foster care because of incomplete demographic data.
AHRQ-funded; HS026372.
Citation: Chaiyachati BH, Wood JN, Mitra N .
All-cause mortality among children in the US foster care system, 2003-2016.
JAMA Pediatr 2020 Sep;174(9):896-98. doi: 10.1001/jamapediatrics.2020.0715..
Keywords: Children/Adolescents, Vulnerable Populations, Mortality
Auger KA, Shah SS, Richardson T
Association between statewide school closure and COVID-19 incidence and mortality in the US.
This study examined whether school closures between March and May due to the beginning of the COVID-19 pandemic was associated with decreased COVID-19 incidence and mortality. States were examined in quartiles using the number of cases per 100,000 population. States with the lowest cumulative incidence had the most significant decline (-72%) in cases compared to states with the highest incidence (-49%). States that closed schools earlier had the largest reduction in incidence and mortality.
AHRQ-funded; HS024735, HS026763, HS025138.
Citation: Auger KA, Shah SS, Richardson T .
Association between statewide school closure and COVID-19 incidence and mortality in the US.
JAMA 2020 Sep;324(9):859-70. doi: 10.1001/jama.2020.14348..
Keywords: COVID-19, Public Health, Children/Adolescents, Policy, Mortality
Lindell RB, Nishisaki A, Weiss SL
Risk of mortality in immunocompromised children with severe sepsis and septic shock.
This study’s objective was to assess the risk of mortality for immunocompromised children admitted to the hospital with septic shock or sepsis. This retrospective multicenter cohort study used eighty-three centers in the Virtual Pediatric systems database. The cohort included children admitted to the pediatric intensive care unit (PICU) with severe sepsis or septic shock from 2012-2016. Across 83 centers, 10,768 PICU admissions with an International Classification of Diseases, 9th Revision, Clinical Modification code for severe sepsis or septic shock were identified; with 3,021 of these patients (28%) having an immunocompromised diagnosis. PICU mortality rates varied widely by center, and those centers with a higher mean number of sepsis patients per month in a center had a lower PICU mortality rate. Multiple prior malignancies, hemophagocytic lymphohistiocytosis, congenital immunodeficiency, and hematopoietic cell transplant are conditions independently associated with an increased odds of PICU mortality in children with severe sepsis or septic shock.
AHRQ-funded; HS024511; HS026939; HS021583; HS022464.
Citation: Lindell RB, Nishisaki A, Weiss SL .
Risk of mortality in immunocompromised children with severe sepsis and septic shock.
Crit Care Med 2020 Jul;48(7):1026-33. doi: 10.1097/ccm.0000000000004329..
Keywords: Children/Adolescents, Mortality, Sepsis, Risk, Intensive Care Unit (ICU), Hospitalization, Hospitals
Williams CN, Eriksson CO, Kirby A
Hospital mortality and functional outcomes in pediatric neurocritical care.
Pediatric neurocritical care (PNCC) outcomes research is scarce. In this study, the investigators aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses. The investigators concluded that PNCC patients had high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability were affected, underscoring the ongoing multidisciplinary health care needs of survivors.
AHRQ-funded; HS022981.
Citation: Williams CN, Eriksson CO, Kirby A .
Hospital mortality and functional outcomes in pediatric neurocritical care.
Hosp Pediatr 2019 Dec;9(12):958-66. doi: 10.1542/hpeds.2019-0173..
Keywords: Children/Adolescents, Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Neurological Disorders, Mortality, Hospitals, Inpatient Care, Outcomes, Patient-Centered Outcomes Research
Spees LP, Martin PL, Kurtzberg J
Reduction in mortality after umbilical cord blood transplantation in children over a 20-year period (1995-2014).
Infections and graft-versus-host disease (GVHD) have historically resulted in high mortality among children undergoing umbilical cord blood transplantation (UCBT). However, recent advances in clinical practice have likely improved outcomes of these patients. In this paper, the authors report on a retrospective cohort study, they conducted, of children (<18years of age) undergoing UCBT at Duke University between January 1, 1995 and December 31, 2014.
AHRQ-funded; HS000032.
Citation: Spees LP, Martin PL, Kurtzberg J .
Reduction in mortality after umbilical cord blood transplantation in children over a 20-year period (1995-2014).
Biol Blood Marrow Transplant 2019 Apr;25(4):756-63. doi: 10.1016/j.bbmt.2018.11.018..
Keywords: Children/Adolescents, Mortality, Outcomes
Haley CA, Brault MA, Mwinga K
Promoting progress in child survival across four African countries: the role of strong health governance and leadership in maternal, neonatal and child health.
The researchers conducted four individual case studies concerning the World Health Organization's African Region Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. They found that strong health governance and leadership (HGL) was a significant driver of the greater success in Liberia and Zambia compared with Kenya and Zimbabwe. Three aspects of HGL which most consistently contributed to the different progress towards MDG#4 among the four study countries were identified. Although child mortality in sub-Saharan Africa remains high, the authors concluded that comparative study suggests key HGL factors that can facilitate the reduction of child mortality and may prove useful in tackling current Sustainable Development Goals.
AHRQ-funded; HS023000.
Citation: Haley CA, Brault MA, Mwinga K .
Promoting progress in child survival across four African countries: the role of strong health governance and leadership in maternal, neonatal and child health.
Health Policy Plan 2019 Feb 1;34(1):24-36. doi: 10.1093/heapol/czy105..
Keywords: Children/Adolescents, Maternal Care, Mortality, Newborns/Infants, Pregnancy
Leyenaar JK, Bogetz JF
Child mortality in the United States: bridging palliative care and public health perspectives.
This commentary discusses the findings of the article by Trowbridge et al in this same issue of Pediatrics, which examines modes of death rather than causes of death at a freestanding children’s hospital. Five distinct categories were created: withdrawal of life-sustaining technology; non-escalation of care; failed resuscitation; code then withdrawal; death by neurological criteria. More than 60% of the deaths were infants. The authors of this commentary note that conceptualizing the findings of this study from a public health perspective raises important questions about how causes of death are associated with end-of-life care in hospitals.
AHRQ-funded; HS024133.
Citation: Leyenaar JK, Bogetz JF .
Child mortality in the United States: bridging palliative care and public health perspectives.
Pediatrics 2018 Oct;142(4). doi: 10.1542/peds.2018-1927..
Keywords: Children/Adolescents, Hospitals, Mortality, Palliative Care, Patient-Centered Outcomes Research, Public Health
Shi J, Shen J, Caupp S
A new weighted injury severity scoring system: Better predictive power for pediatric trauma mortality.
The objective of this study was to develop a weighted Injury Severity Score (wISS) system for pediatric blunt trauma patients with better predictive power than ISS. The authors suggest that by weighting the Abbreviated Injury Scale from different body regions, the wISS had significantly better predictive power for mortality than the ISS, especially in critically injured children.
AHRQ-funded; HS024263.
Citation: Shi J, Shen J, Caupp S .
A new weighted injury severity scoring system: Better predictive power for pediatric trauma mortality.
J Trauma Acute Care Surg 2018 Aug;85(2):334-40. doi: 10.1097/ta.0000000000001943..
Keywords: Children/Adolescents, Injuries and Wounds, Mortality, Children/Adolescents, Trauma
Hartman ME, Saeed MJ, Bennett T
Readmission and late mortality after critical illness in childhood.
Researchers sought to understand risks for hospital readmission and trends in mortality during the year following ICU discharge. They found that, in multivariate analysis, risk of nonelective readmission for children without cancer was higher with longer index ICU admission length of stay, younger age, and several chronic and acute conditions. Mortality in the year after ICU discharge was low overall.
AHRQ-funded; HS019455.
Citation: Hartman ME, Saeed MJ, Bennett T .
Readmission and late mortality after critical illness in childhood.
Pediatr Crit Care Med 2017 Mar;18(3):e112-e21. doi: 10.1097/pcc.0000000000001062.
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Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Mortality, Hospital Readmissions
Wilkes JJ, Hennessy S, Xiao R
Volume-outcome relationships in pediatric acute lymphoblastic leukemia: association between hospital pediatric and pediatric oncology volume with mortality and intensive care resources during initial therapy.
Researchers investigated if inpatient hospital volume influences outcomes. The objective of their study was to evaluate the relationship between inpatient pediatric and pediatric oncology volume and mortality and intensive care resources (ICU care). It concluded that induction mortality was low and that there was no inverse relationship between volume and mortality or ICU care.
AHRQ-funded; HS023419.
Citation: Wilkes JJ, Hennessy S, Xiao R .
Volume-outcome relationships in pediatric acute lymphoblastic leukemia: association between hospital pediatric and pediatric oncology volume with mortality and intensive care resources during initial therapy.
Clin Lymphoma Myeloma Leuk 2016 Jul;16(7):404-10.e1. doi: 10.1016/j.clml.2016.04.016.
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Keywords: Cancer, Children/Adolescents, Hospitalization, Mortality, Outcomes
Jenkins KJ, Koch Kupiec J, Owens PL
AHRQ Author: Owens PL
Development and validation of an Agency for Healthcare Research and Quality indicator for mortality after congenital heart surgery harmonized with risk adjustment for congenital heart surgery (RACHS-1) methodology.
The National Quality Forum previously approved a quality indicator for mortality after congenital heart surgery developed by AHRQ. Several parameters of the validated Risk Adjustment for Congenital Heart Surgery (RACHS-1) method were included, but others differed. As part of the National Quality Forum endorsement maintenance process, developers were asked to harmonize the 2 methodologies.
AHRQ-authored.
Citation: Jenkins KJ, Koch Kupiec J, Owens PL .
Development and validation of an Agency for Healthcare Research and Quality indicator for mortality after congenital heart surgery harmonized with risk adjustment for congenital heart surgery (RACHS-1) methodology.
J Am Heart Assoc 2016 May;5(5):pii: e003028. doi: 10.1161/jaha.115.003028.
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Keywords: Surgery, Mortality, Quality Indicators (QIs), Children/Adolescents, Cardiovascular Conditions
Aalsma MC, Lau KS, Perkins AJ
Mortality of youth offenders along a continuum of justice system involvement.
This study of youth offenders in Marion County, Indiana, found a greater risk for early mortality than for community youth. The risk increased as justice system involvement became more severe. Black male youth had the highest risk.
AHRQ-funded; HS022681.
Citation: Aalsma MC, Lau KS, Perkins AJ .
Mortality of youth offenders along a continuum of justice system involvement.
Am J Prev Med 2016 Mar;50(3):303-10. doi: 10.1016/j.amepre.2015.08.030.
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Keywords: Children/Adolescents, Mortality, Racial and Ethnic Minorities
Lee GE, Fisher BT, Xiao R
Burden of influenza-related hospitalizations and attributable mortality in pediatric acute lymphoblastic leukemia.
The researchers investigated the rate of influenza hospitalizations and attributable mortality in children with cancer. They concluded that the burden of influenza-related hospitalizations in children with acute lymphoblastic leukemia is high and associated with significantly increased resource utilization and attributable mortality.
AHRQ-funded; HS020939.
Citation: Lee GE, Fisher BT, Xiao R .
Burden of influenza-related hospitalizations and attributable mortality in pediatric acute lymphoblastic leukemia.
J Pediatric Infect Dis Soc 2015 Dec;4(4):290-6. doi: 10.1093/jpids/piu066..
Keywords: Children/Adolescents, Hospitalization, Influenza, Mortality, Children/Adolescents
Cauley RP, Potanos K, Fullington N
Pulmonary support on day of life 30 is a strong predictor of increased 1 and 5-year morbidity in survivors of congenital diaphragmatic hernia.
The researchers aimed to determine if the degree of pulmonary support (PS) on day of life 30 (DOL-30) could be a simple cross-institutional tool for identifying those patients with a higher risk of long-term morbidity. They found that PS on DOL-30 is a strong independent predictor of morbidity at 1 and 5-years and may be used as a simple prognostic tool to identify high-risk infants.
AHRQ-funded; HS019485.
Citation: Cauley RP, Potanos K, Fullington N .
Pulmonary support on day of life 30 is a strong predictor of increased 1 and 5-year morbidity in survivors of congenital diaphragmatic hernia.
J Pediatr Surg 2015 May;50(5):849-55. doi: 10.1016/j.jpedsurg.2014.12.007..
Keywords: Children/Adolescents, Mortality, Outcomes
Conlon TW, Falkensammer CB, Hammond RS
Association of left ventricular systolic function and vasopressor support with survival following pediatric out-of-hospital cardiac arrest.
This study characterizes the association of hospital discharge survival with left ventricular systolic function evaluated by transthoracic echocardiography and vasoactive infusion support following return of spontaneous circulation after pediatric out-of-hospital cardiac arrest. It found that in patients receiving transthoracic echocardiography within the first 24 hours, decreased left ventricular systolic function and vasopressor use were common.
AHRQ-funded; HS022464.
Citation: Conlon TW, Falkensammer CB, Hammond RS .
Association of left ventricular systolic function and vasopressor support with survival following pediatric out-of-hospital cardiac arrest.
Pediatr Crit Care Med 2015 Feb;16(2):146-54. doi: 10.1097/pcc.0000000000000305..
Keywords: Children/Adolescents, Hospital Discharge, Mortality, Heart Disease and Health