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- Adverse Events (3)
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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 DisplayedDhudasia MB, Benitz WE, Flannery DD
Diagnostic performance and patient outcomes with c-reactive protein use in early-onset sepsis evaluations.
This study’s objective was to determine performance of C-reactive protein (CRP) in the diagnosis of early-onset sepsis, and to assess patient outcomes with and without routine use of CRP in infants in the neonatal intensive care unit (NICU). This retrospective cohort study looked at infants admitted to 2 NICUs from 2009 to 2014. During the time period, 10,134 infants were admitted, 89.9% had CRP, and 74.5% had blood culture obtained within 3 days of birth. CRP obtained plus/minus 4 hours had a sensitivity of 41.7%, specificity 89.9%, and positive likelihood ratio 4.12 in diagnosis of early-onset sepsis. When obtained 24-72 hours after blood culture, sensitivity of CRP increased significantly (89.5%), but specificity (55.7%) and positive likelihood ratio (2.02) decreased. Comparing the periods with (n = 4977) and without (n = 5135) routine use of CRP, the authors observed lower rates of early-onset sepsis evaluation (74.5% vs 50.5%), antibiotic initiation (65.0% vs 50.8%), and antibiotic prolongation in the absence of early-onset sepsis (17.3% vs 7.2%) in the later period.
AHRQ-funded; HS027468.
Citation: Dhudasia MB, Benitz WE, Flannery DD .
Diagnostic performance and patient outcomes with c-reactive protein use in early-onset sepsis evaluations.
J Pediatr 2023 May; 256:98-104.e6. doi: 10.1016/j.jpeds.2022.12.007..
Keywords: Newborns/Infants, Sepsis, Diagnostic Safety and Quality
Tabatneck ME, He W, Lamb GS
Interferon gamma release asssay results and testing trends among patients younger than 2 years old at two US health centers.
Researchers performed a retrospective cohort study of interferon-gamma release assay (IGRA) use for the diagnosis of tuberculosis infection in patients under 2 years old in two large Boston healthcare systems. A total of 321 IGRA results were analyzed; over 90 percent were valid. The proportion of invalid/indeterminate results was found to be significantly higher among immunocompromised patients. The researchers concluded that the high proportion of valid IGRA test results in patients less than 2 years of age in a low TB prevalence setting supported the adoption of IGRAs for this age group in certain clinical scenarios. They note that the interpretation of IGRAs, particularly in immunocompromised patients, should consider the broader clinical context.
AHRQ-funded; HS000063.
Citation: Tabatneck ME, He W, Lamb GS .
Interferon gamma release asssay results and testing trends among patients younger than 2 years old at two US health centers.
Pediatr Infect Dis J 2023 Mar; 42(3):189-94. doi: 10.1097/inf.0000000000003794..
Keywords: Newborns/Infants, Diagnostic Safety and Quality, Infectious Diseases
Shafer GJ, Singh H, Thomas EJ
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
The objective of this study was to determine the frequency and etiology of diagnostic errors during the first 7 days of admission for inborn neonatal intensive care unit (NICU) patients. The "Safer Dx NICU Instrument" was used to review electronic health records. The reviewers discovered that the frequency of diagnostic error in inborn NICU patients during the first 7 days of admission was 6.2%.
AHRQ-funded; HS027363.
Citation: Shafer GJ, Singh H, Thomas EJ .
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
J Perinatol 2022 Oct;42(10):1312-18. doi: 10.1038/s41372-022-01359-9..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Michelson KA, Neuman MI, Pruitt CM
Height of fever and invasive bacterial infection.
This study evaluated the association of higher fevers with invasive bacterial infection (IBI) among febrile infants ≤60 days of age. Maximum temperatures of febrile infants with IBI were compared to infants without IBI. The median temperature was higher for infants with IBI (38.8°C) compared to those without IBI (38.4°C). Temperatures ranges of 39°C-39.4°C and 39.5°C-39.9°C were associated with a higher likelihood of IBI, although 30.4% of febrile infants with IBI had maximum temperatures <38.5°C.
AHRQ-funded; HS026006; HS026503.
Citation: Michelson KA, Neuman MI, Pruitt CM .
Height of fever and invasive bacterial infection.
Arch Dis Child 2021 Jun;106(6):594-96. doi: 10.1136/archdischild-2019-318548..
Keywords: Newborns/Infants, Infectious Diseases, Diagnostic Safety and Quality, Risk
Vemulakonda VM
Ureteropelvic junction obstruction: diagnosis and management.
Ureteropelvic junction obstruction (UPJO) is the most common cause of prenatally diagnosed hydronephrosis. Although associated with obstruction of the kidney, the natural history is variable, ranging from spontaneous resolution to progressive loss of function over the first few years of life. The purpose of this article is to review recent literature focused on the prenatal and postnatal evaluation of infants with prenatally diagnosed hydronephrosis suspicious for UPJO.
AHRQ-funded; HS024597.
Citation: Vemulakonda VM .
Ureteropelvic junction obstruction: diagnosis and management.
Curr Opin Pediatr 2021 Apr 1;33(2):227-34. doi: 10.1097/mop.0000000000000994..
Keywords: Newborns/Infants, Pregnancy, Diagnostic Safety and Quality
Yankova LC, Neuman MI, Wang ME
Febrile infants ≤60 days old with positive urinalysis results and invasive bacterial infections.
In this study, the investigators aimed to describe the clinical and laboratory characteristics of febrile infants ≤60 days old with positive urinalysis results and invasive bacterial infections (IBI). The investigators concluded that the sensitivity of high-risk PMH, ill appearance, and/or abnormal WBC count was suboptimal for identifying febrile infants with positive urinalysis results at low risk for IBI.
AHRQ-funded; HS026006.
Citation: Yankova LC, Neuman MI, Wang ME .
Febrile infants ≤60 days old with positive urinalysis results and invasive bacterial infections.
Hosp Pediatr 2020 Dec;10(12):1120-25. doi: 10.1542/hpeds.2020-000638..
Keywords: Newborns/Infants, Urinary Tract Infection (UTI), Diagnostic Safety and Quality
Feldman AG, Sokol RJ
Recent developments in diagnostics and treatment of neonatal cholestasis.
This review discusses recent advances in diagnosis and treatment of neonatal cholestatis, which is a sign common to over 100 hepatobiliary and/or metabolic disorders. Advances in genetic testing and bioinformatics have led to an expanding group of molecularly defined disorders involving bile formation, canalicular transporters, tight junction proteins and inborn errors of metabolism. This has enabled rapid and affordable molecular diagnosis for disorders that cannot be directly diagnosed from standard blood tests or liver biopsy.
AHRQ-funded; HS026510.
Citation: Feldman AG, Sokol RJ .
Recent developments in diagnostics and treatment of neonatal cholestasis.
Semin Pediatr Surg 2020 Aug;29(4):150945. doi: 10.1016/j.sempedsurg.2020.150945..
Keywords: Diagnostic Safety and Quality, Newborns/Infants
Brower LH, Wilson PM, Murtagh-Kurowski E
Evaluation for neonatal HSV in infants undergoing workup for serious bacterial infection: a 5-year retrospective review.
The purpose of this study was to describe the characteristics of infants evaluated for serious bacterial infection, focusing on empirical testing and treatment of herpes simplex virus (HSV) and describe the characteristics of HSV-positive patients. The investigators concluded that the absence of fever should not preclude a workup for HSV in neonates, and when a workup is initiated, emphasis should be placed on obtaining samples from serum, cerebrospinal fluid, and surface specimens.
AHRQ-funded; HS026763.
Citation: Brower LH, Wilson PM, Murtagh-Kurowski E .
Evaluation for neonatal HSV in infants undergoing workup for serious bacterial infection: a 5-year retrospective review.
Hosp Pediatr 2020 Jun;10(6):463-70. doi: 10.1542/hpeds.2020-0033..
Keywords: Newborns/Infants, Infectious Diseases, Diagnostic Safety and Quality
Henry MK, Feudtner C, Fortin K
Occult head injuries in infants evaluated for physical abuse.
Abusive head injuries in infants may be occult but clinically or forensically important. Data conflict regarding yield of neuroimaging in detecting occult head injuries in infants evaluated for physical abuse, with prior studies identifying yields of 4.3-37.3 %. The objectives of this study were (1) To quantify yield of computed tomography or magnetic resonance imaging in identification of occult head injuries in infants with concerns for physical abuse and (2) To evaluate risk factors for occult head injuries.
AHRQ-funded; HS024194.
Citation: Henry MK, Feudtner C, Fortin K .
Occult head injuries in infants evaluated for physical abuse.
Child Abuse Negl 2020 May;103:104431. doi: 10.1016/j.chiabu.2020.104431..
Keywords: Newborns/Infants, Brain Injury, Domestic Violence, Imaging, Diagnostic Safety and Quality, Injuries and Wounds
Beam K, Wojcik MH, Agrawal PB
Prenatal diagnosis of a ventral abdominal wall defect.
This paper is a case study describing an infant diagnosed prenatally with fetal ultrasonography with multiple abnormalities including a ventral abdominal wall defect and confirmed herniation of the liver with the portal vein extending outside the abdomen, stomach, small bowel, and majority of the large bowel without an overlying membrane. The kidneys were enlarged as well. Multiple surgeries were performed. Ultimately the infant died 38 days after birth.
AHRQ-funded; HS000063.
Citation: Beam K, Wojcik MH, Agrawal PB .
Prenatal diagnosis of a ventral abdominal wall defect.
Neoreviews 2020 Apr;21(4):e286-e92. doi: 10.1542/neo.21-4-e286..
Keywords: Newborns/Infants, Diagnostic Safety and Quality, Case Study
Shafer G, Singh H, Suresh G
Diagnostic errors in the neonatal intensive care unit: state of the science and new directions.
In this narrative review, the authors discuss how the concept of diagnostic errors framed as missed opportunities can be applied to the non-linear nature of diagnosis in a critical care environment such as the NICU. They then explore how the etiology of an error in diagnosis can be related to both individual cognitive factors as well as organizational and systemic factors - all of which often contribute to the error.
AHRQ-funded; HS022087.
Citation: Shafer G, Singh H, Suresh G .
Diagnostic errors in the neonatal intensive care unit: state of the science and new directions.
Semin Perinatol 2019 Dec;43(8):151175. doi: 10.1053/j.semperi.2019.08.004..
Keywords: Newborns/Infants, Diagnostic Safety and Quality, Neonatal Intensive Care Unit (NICU), Medical Errors, Adverse Events, Patient Safety
Aronson PL, Cruz AT, Freedman SB
Association of herpes simplex virus testing with hospital length of stay for infants </=60 days of age undergoing evaluation for meningitis.
The objective of this study was to examine the association of cerebrospinal fluid herpes simplex virus polymerase chain reaction (CSF HSV PCR) testing with length of stay in a 20-center retrospective cohort of hospitalized infants aged </=60 days undergoing evaluation for meningitis after adjustment for patient-level factors and clustering by center. The investigators found that of 20,496 eligible infants, 7,399 (36.1%) had a CSF HSV PCR test performed, and 46 (0.6% of those tested) had a positive test.
AHRQ-funded; HS026006.
Citation: Aronson PL, Cruz AT, Freedman SB .
Association of herpes simplex virus testing with hospital length of stay for infants </=60 days of age undergoing evaluation for meningitis.
J Hosp Med 2019 Aug;14(8):492-95. doi: 10.12788/jhm.3202..
Keywords: Diagnostic Safety and Quality, Infectious Diseases, Newborns/Infants
Aronson PL, Schaeffer P, Fraenkel L
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
This paper discusses the reasons for wide variation in the decision to perform lumbar punctures (LPs) in febrile infants 8 weeks or less. Semi-structured interviews were conducted with 15 pediatric and general emergency medicine physicians and 8 pediatric emergency medicine nurses at an urban, academic medical center. Five themes emerged from the interviews that included: age of the infant, the physician’s clinical experience, physician’s use of research findings, the physician’s values, and the role of the primary care pediatrician.
AHRQ-funded; HS026006.
Citation: Aronson PL, Schaeffer P, Fraenkel L .
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
Hosp Pediatr 2019 Jun;9(6):405-14. doi: 10.1542/hpeds.2019-0002..
Keywords: Newborns/Infants, Decision Making, Provider: Physician, Provider: Nurse, Provider: Clinician, Provider, Emergency Department, Diagnostic Safety and Quality
Pouppirt NR, Nassar R, Napolitano N
Association between video laryngoscopy and adverse tracheal intubation-associated events in the neonatal intensive care unit.
The purpose of this single-site retrospective cohort study was to consider the possible effect of video laryngoscopy on adverse events during neonatal tracheal intubation. The researchers conclude that video laryngoscopy was independently associated with decreased risk for adverse events.
AHRQ-funded; HS022464; HS024511.
Citation: Pouppirt NR, Nassar R, Napolitano N .
Association between video laryngoscopy and adverse tracheal intubation-associated events in the neonatal intensive care unit.
J Pediatr 2018 Oct;201:281-84.e1. doi: 10.1016/j.jpeds.2018.05.046..
Keywords: Adverse Events, Diagnostic Safety and Quality, Neonatal Intensive Care Unit (NICU), Newborns/Infants, Patient Safety
Gephart SM, Wyles C, Canvasser J
Expert consensus to weight an adherence score for audit and feedback of practices that prevent necrotizing enterocolitis in very low birth weight infants.
Necrotizing enterocolitis (NEC) is a catastrophic abdominal complication threatening the life of premature infants, but adoption of prevention and early recognition practices differs as do NEC rates in Neonatal Intensive Care Units (NICUs). The purpose of this research was to validate and weight an evidence-based adherence score (aka NEC-Zero Adherence Score) to prevent and foster timely recognition of NEC.
AHRQ-funded; HS022908.
Citation: Gephart SM, Wyles C, Canvasser J .
Expert consensus to weight an adherence score for audit and feedback of practices that prevent necrotizing enterocolitis in very low birth weight infants.
Appl Nurs Res 2018 Feb;39:182-88. doi: 10.1016/j.apnr.2017.11.021..
Keywords: Newborns/Infants, Digestive Disease and Health, Diagnostic Safety and Quality, Intensive Care Unit (ICU)
Gephart SM, Gordon PV, Penn AH
Changing the paradigm of defining, detecting, and diagnosing NEC: perspectives on Bell's stages and biomarkers for NEC.
This article provides reasons why a better global definition for necrotizing enterocolitis (NEC) is needed and offers a simple alternative bedside definition for preterm NEC called the "Two out of Three" rule.
AHRQ-funded; HS022908.
Citation: Gephart SM, Gordon PV, Penn AH .
Changing the paradigm of defining, detecting, and diagnosing NEC: perspectives on Bell's stages and biomarkers for NEC.
Semin Pediatr Surg 2018 Feb;27(1):3-10. doi: 10.1053/j.sempedsurg.2017.11.002..
Keywords: Diagnostic Safety and Quality, Newborns/Infants
Letourneau LR, Carmody D, Wroblewski K
Diabetes presentation in infancy: high risk of diabetic ketoacidosis.
In this study, the largest of its kind, diabetic ketoacidosis (DKA) was more frequent than in other early-onset U.S. studies or other cohorts of patients with neonatal diabetes. The authors argue that continuing to educate pediatric providers about the many ways that infants can present with diabetes may help to diagnose cases more efficiently and ultimately decrease the frequency of DKA at diagnosis.
AHRQ-funded; HS023007.
Citation: Letourneau LR, Carmody D, Wroblewski K .
Diabetes presentation in infancy: high risk of diabetic ketoacidosis.
Diabetes Care 2017 Oct;40(10):e147-e48. doi: 10.2337/dc17-1145.
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Keywords: Diabetes, Diagnostic Safety and Quality, Newborns/Infants, Children/Adolescents
Gephart SM, Fleiner M, Kijewski A
The ConNECtion between abdominal signs and necrotizing enterocolitis in infants 501 to 1500 g.
Necrotizing enterocolitis (NEC) can become severe quickly, making early recognition a priority and understanding the occurrence of abdominal and clinical signs of impending NEC important. The purpose of this study was to examine relationships of abdominal signs up to 36 hours before diagnosis of NEC within subgroups treated medically, surgically, or those who died.
AHRQ-funded; HS022908.
Citation: Gephart SM, Fleiner M, Kijewski A .
The ConNECtion between abdominal signs and necrotizing enterocolitis in infants 501 to 1500 g.
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Keywords: Children/Adolescents, Diagnostic Safety and Quality, Newborns/Infants