bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Computed Tomography on Patient Management and Costs in Children With Suspected Appendicitis
Authors: Peña Barbara M. Garcia , Taylor George A. , Lund Dennis P. , Mandl Kenneth D. 
Published: August 2004

Objective.Children evaluated in the emergency department for possible appendicitis are often admitted for observation, despite the widespread availability of accurate diagnostic studies, particularly computed tomography (CT). We sought to establish effective and efficient strategies for using CT to diagnose and manage children with possible appendicitis.Design.Retrospective chart review and decision analysis.Setting.Emergency department of a large, urban tertiary care pediatric teaching hospital.Patients.All patients admitted from January 1996 to August 1997 for suspected appendicitis.Method of Analysis.Three modeled strategies were empirically applied to the retrospective cohort of patients admitted for observation. Outcomes and costs under the modeled strategies were compared with those under current practice. The three strategies were: 1) to obtain CT scans on all patients and discharge those with normal findings; 2) to obtain CT scans and admit all patients; 3) to selectively obtain CT scans on those patients with a peripheral white blood cell count &gt;10 000/mm3 (10 × 109/L) and admit all. The sensitivity and specificity of CT for diagnosing appendicitis were determined empirically from the data. A sensitivity analysis was performed.Main Outcome Measures.The number of preoperative inpatient observation days, total hospital costs, and the rates of both missed appendicitis and negative laparotomies.Results.Of 609 patients hospitalized for possible appendicitis, 287 went directly to the operating room and 14 patients had known perforation and abscess. Three hundred eight children were observed and comprised the study cohort. Of the cohort, 112 (36.4%) underwent appendectomy and 26 (23.2%) of these had a normal appendix at pathology. Three patients were discharged from the hospital after observation and were subsequently readmitted with appendicitis (missed appendicitis). Among the 75 patients who had CT performed, the sensitivity and specificity of CT were both 97%. Under the current practice strategy, the cohort collectively accumulated 487 inpatient observation days and incurred a per patient cost of $5831. All three CT strategies would have reduced the total number of inpatient observation days, operations, negative laparotomies, as well as the per patient cost. The strategy of obtaining CT scans on all patients and then admitting them had the lowest rate of missed appendicitis. The additional cost of preventing each case of missed appendicitis under this strategy compared with the strategy of obtaining CT scans and sending home those with negative findings was $150 304. Even at the lowest reported sensitivity and specificity of CT in the literature, the ordering of the three strategies remained constant and continued to reduce total cost per patient.Conclusion.Compared with current practice, diagnostic strategies using CT could reduce costs and improve diagnosis, management, and outcomes for children with appendicitis.
Reduction of Unnecessary Antibiotic Therapy in Newborn Infants Using Interleukin-8 and C-Reactive Protein as Markers of Bacterial Infections
Authors: Franz Axel R. , Steinbach Gerald , Kron Martina , Pohlandt Frank 
Published: August 2004

Objective.To examine whether the determination of interleukin 8 (IL-8) and C-reactive protein (CRP) in neonates with suspected nosocomial bacterial infection (NBI) is feasible and cost-effective in reducing antibiotic therapy.Methods.Between April 1996 and May 1997, IL-8 was measured 260 times along with blood cultures, CRP, and immature-to-total-neutrophil (IT) ratio for suspected NBI in term and preterm neonates. All infants were retrospectively analyzed for NBI. Sensitivity, specificity, positive and negative predictive values, and 95% confidence intervals were calculated for IL-8, CRP, and IT ratio. Receiver-operating characteristic curves were analyzed to determine optimal thresholds. Between June 1997 and June 1998, IL-8 was measured 215 times in newborn infants with suspected NBI and the decision to start antibiotic therapy was based on increased IL-8 and/or CRP values. A cost-effectiveness analysis was performed and sensitivity, specificity, and receiver-operating characteristic curves were reevaluated.Results.At the first suspicion of NBI, the combination of IL-8 ≥ 53 pg/mL and/or CRP &gt;10 mg/L detected culture-proven NBI with 96% sensitivity. The combined culture-proven and clinical NBI were detected with 93% sensitivity and 80% specificity. The use of IL-8 reduced unnecessary antibiotic therapy for suspected NBI by 73% and was cost-effective when compared with initiating antibiotic therapy based on clinical signs alone or based on clinical signs and an increased IT ratio and/or CRP.Conclusions.The combination of IL-8 and/or CRP is a reliable and early test for the diagnosis of NBI in newborn infants. Using the combination of IL-8 and/or CRP to restrict antibiotic therapy to truly infected infants reduces unnecessary antibiotic therapy and is cost-effective.
Predicting Deterioration in Previously Healthy Infants Hospitalized With Respiratory Syncytial Virus Infection
Authors: Brooks Ann-Marie , McBride John T. , McConnochie Kenneth M. , Aviram Micah , Long Christine , Hall Caroline B. 
Published: August 2004

Objective.To estimate the incidence of clinical deterioration leading to intensive care unit transfer in previously healthy infants with respiratory syncytial virus (RSV) infection hospitalized on a general pediatric unit and, to assess the hypothesis that history, physical examination, oximetry, and chest radiographic findings at time of presentation can accurately identify these infants.Study Design.A virology database was used to identify and determine the disposition of all children ≤1 year of age admitted to the Children's Hospital at Strong (CHaS) with RSV infection during the 1985 to 1994 respiratory seasons. Index patients were all previously healthy, full-term infants admitted initially to the general inpatient services at CHaS or Rochester General Hospital, a second University of Rochester teaching hospital, whose clinical deterioration led to transfer to the pediatric intensive care unit (PICU). These infants were matched retrospectively (for year and date of infection, sex, chronologic age, and race) with two hospitalized controls who did not require PICU transfer. Chest radiographic findings, respiratory rate (RR), O2 saturation, and presence of wheezing at time of presentation to the emergency department (ED) were compared.Results.During the study years, 542 previously healthy, full-term infants were admitted to the general pediatric unit at CHaS with proven RSV infection. Ten (1.8%; 95% confidence interval, 0.9%, 3.4%) were transferred subsequently to the PICU, primarily for close monitoring of progressive respiratory distress. Data for these patients and 7 patients transferred from Rochester General Hospital to the PICU at the CHaS were compared with those for control patients. The mean RR in the ED (63 vs 50), and O2 saturation in the ED (88% vs 93%) were modestly abnormal in cases compared with controls. Wheezing on examination at time of presentation and chest radiographic findings did not differ between the two groups. A RR &gt;80 and an O2saturation &lt;85% at time of presentation each had a specificity &gt;97% for predicting subsequent deterioration. Each parameter, however, had a sensitivity ≤30%.Conclusion.Clinical deterioration requiring PICU admission is an uncommon occurrence in previously healthy infants admitted to a general pediatric inpatient unit with RSV infection. Extreme tachypnea and hypoxemia were both associated with subsequent deterioration; however, only a small proportion of patients who clinically deteriorated presented in this way. The clinical usefulness of these parameters, therefore, is limited. respiratory syncytial virus, deterioration, healthy infants, prediction.
Use of State Hospital Discharge Data to Assess the Morbidity From Rotavirus Diarrhea and to Monitor the Impact of a Rotavirus Immunization Program: A Pilot Study in Connecticut
Authors: Parashar Umesh D. , Chung Marc A. , Holman Robert C. , Ryder Robert W. , Hadler James L. , Glass Roger I. 
Published: August 2004

Objectives.Now that rotavirus vaccines have been licensed and recommended for routine immunization of US infants, there is an urgent need for data to assess the morbidity from rotavirus diarrhea and to monitor the impact of a rotavirus immunization program. In a pilot study, we have assessed the usefulness of state hospital discharge data on diarrhea in children to provide this information by examining data from Connecticut.Design.Retrospective analysis of discharge records from acute care, nongovernmental hospitals in Connecticut.Patients.Children 1 month through 4 years of age with a diarrhea-associated diagnosis listed on the discharge record.Setting.Connecticut, 1987 through 1996.Results.During the 10-year study period, a total of 11 324 diarrhea-associated hospitalizations (49.4 hospitalizations per 10 000 children) were reported. Diarrhea-associated hospitalizations peaked during February through April, especially among children 4 to 35 months of age. The seasonality and age distribution of diarrhea-associated hospitalizations of presumed noninfectious and viral etiologies resembled those of rotavirus-associated hospitalizations. During 1993 to 1996, rotavirus was coded for 10.4% of diarrhea-associated hospitalizations increasing from 8.6% in 1993 to 14.7% in 1996. The unadjusted median cost of a diarrhea-associated hospitalization during 1987 to 1996 and 1993 to 1996 was $1941 and $2428, respectively.Conclusions.Diarrhea causes substantial morbidity in children from Connecticut. The winter seasonal peak of diarrhea-associated hospitalizations in children 4 to 35 months of age coinciding with the peak of rotavirus-specific hospitalizations suggests that rotavirus is an important contributor to the overall morbidity. Although our findings suggest incomplete coding of rotavirus cases, state hospital discharge data should provide sensitive and timely information to monitor the impact of a rotavirus immunization program in Connecticut.
Prevention of Exercise-induced Bronchospasm in Pediatric Asthma Patients: A Comparison of Two Salmeterol Powder Delivery Devices
Authors: Bronsky Edwin A. , Pearlman David S. , Pobiner Bonnie F. , Scott Catherine , Wang Yonghua , Stahl Edmundo 
Published: August 2004

Background.
A powder formulation of salmeterol has been shown to prevent exercise-induced bronchospasm (EIB) in asthmatic children and adults; however, the delivery device (Diskhaler; Glaxo Wellcome Inc, Research Triangle Park, NC) must be reloaded after 4 doses. A new multidose powder inhaler (Diskus) provides 60 doses of salmeterol in a blister pack presentation with a dose counter.

Objective.
To evaluate the safety and efficacy of 50-μg salmeterol powder via two different delivery systems (Diskhaler and Diskus) in preventing EIB in asthmatic children.

Study Design.
A randomized, double-blind, double-dummy, single-dose, placebo-controlled, three-way crossover study was conducted in 24 children 4 to 11 years of age demonstrating EIB and mild to moderate asthma. Serial forced expiratory volume in 1 second (FEV1) was measured before and after treadmill exercise challenges conducted at 1, 6, and 12 hours after study drug administration. Adverse events were also assessed.

Results.
During all exercise challenges, EIB-mediated reductions in FEV1 were minimized or prevented in patients receiving single doses of salmeterol powder compared with placebo. Single doses of salmeterol powder delivered via either system were equally effective in preventing EIB. There were no drug-related adverse events, cardiovascular, or other clinically relevant safety concerns.

Conclusions.
Single doses of salmeterol powder delivered by either delivery system are safe and effective in preventing EIB for ≥12 hours in asthmatic children.
Crowd Out: Evidence From the Florida Healthy Kids Program
Authors: Shenkman Elizabeth , Bucciarelli Richard , Wegener Donna Hope , Naff Rose , Freedman Steve 
Published: August 2004

Objective.
To determine the percentage of children who had insurance coverage in the 12 months preceding enrollment in a state-subsidized program; the percentage of parents who had access to employer-based family coverage; and the cost of the families' share of the premium per month.

Methods.
We randomly selected 930 families whose children were enrolled in the Florida Healthy Kids Program for a period of between 1 and 3 months and conducted telephone interviews with them in 1998 about their children's insurance coverage before program entry and their access to employer-based family coverage. There were 653 families in the final sample.

Results.
Only 5% of the children had employer-based coverage before program enrollment. However, 26% had access to family coverage through their employers with the family share of the premiums representing on average 13% of their incomes. Access to employer-based coverage varied significantly by family income.

Conclusions.
Throughout the development of the State Children's Health Insurance Program legislation, policy analysts expressed concern that families may crowd out or substitute a subsidized state plan for employer-based coverage. This substitution could result in fewer improvements in access to care and health status than were anticipated, because families are simply moving to a different form of health insurance. There is some degree of crowd out in the Healthy Kids Program. The economic burden to near-poor families to purchase employer-based coverage is significant. Some degree of substitution may need to be tolerated to ensure that children receive needed health insurance.
Comparison of Perinatal Outcomes Among TennCare Managed Care Organizations
Authors: Cooper William O. , Hickson Gerald B. , Mitchel Edward F. , MS Jr, , Ray Wayne A. 
Published: August 2004

Objective.
To compare perinatal outcomes among the managed care organizations (MCOs) providing care to beneficiaries enrolled in TennCare, Tennessee's capitated Medicaid managed care program.

Design.
Retrospective cohort analysis.

Subjects.
Infants born in Tennessee during 1995 to women enrolled in TennCare.

Primary Outcome Measures.
Prenatal care use, birth weight (BW), death in the first 60 days of life, and delivery of extremely low BW (&lt;1000 g) infants in hospitals without level 3 neonatal intensive care units.

Results.
During 1995, 34 402 infants were born to mothers enrolled in TennCare. The MCOs differed widely in the demographic characteristics of their enrollees. In addition, there were small differences in prenatal care utilization, but no differences in BW outcomes among the MCOs. In multivariate analysis, however, infants born to women enrolled in 1 MCO were 2.8 times more likely to die in the first 60 days of life than were infants born to women enrolled in the largest MCO (OR: 2.81; 95% CI: 1.31–6.03). Women enrolled in this same MCO seemed to have a higher proportion of extremely low BW (&lt;1000 g) infants delivering in a hospital lacking a level 3 neonatal intensive care unit (38% vs 20% in the largest MCO).

Conclusion.
The differences among MCOs in early infant death and in the delivery of high-risk infants in hospitals lacking appropriate neonatal facilities suggest that monitoring of care delivery to vulnerable children should include assessment of appropriate use of specialized services.
Firearm Injury Prevention Counseling: Are We Missing the Mark?
Authors: Becher Elise C. , Christakis Nicholas A. 
Published: August 2004

Objective.To determine whether pediatricians accurately estimate the likelihood of gun ownership among their patients' families.Design.Self-administered, written surveys completed simultaneously by pediatricians and their patients' parents.Setting.A total of 23 pediatric practices and hospital-based clinics in three cities in the United States.Subjects.A total of 66 pediatricians paired with 169 of their patients' parents.Main Outcome Measures.Parent survey: ownership and storage of guns, willingness to admit gun ownership, and previous counseling by pediatrician. Pediatrician survey: estimated prevalence of gun ownership, likelihood of gun ownership by each participant family, and beliefs about firearm injury prevention counseling.Results.All parents who owned guns indicated they would acknowledge owning a gun if asked by their pediatricians. Of the participating families, 28% owned at least one gun; 39% of the homes with guns contained a gun that was unlocked, loaded, or both. Of the parents, 11% reported that their pediatrician had discussed firearm safety with them. Pediatricians' average estimate of the overall prevalence of gun ownership in their patient populations was 25%. When asked to predict the likelihood of gun ownership by the specific families in the study, pediatricians predicted a 0% likelihood of gun ownership for 33% of the families. Of those families, 30% reported owning at least one gun. Considering physician predictions of any likelihood of gun ownership &gt;0% (1%–100%) to be a positive prediction and using parent reports as the gold standard, physician estimates of gun ownership were only 65% sensitive. Approximately half (55%) of the participating pediatricians believed that pediatricians should discuss gun safety with all families, and 98% believed that pediatricians should discuss gun safety with all gun-owning families.Conclusions.Pediatricians believe that all families with guns should receive firearm safety counseling. However, pediatricians significantly underestimate the likelihood of gun ownership by specific families. Parents who own guns indicate that they would acknowledge gun ownership if their pediatrician asked about guns in the home. Therefore, rather than relying on assumptions about whether particular patients seem likely to be gun owners, pediatricians should ask all families whether they own guns.
Current Incidence of Retinopathy of Prematurity, 1989–1997
Authors: Hussain Naveed , Clive Jonathan , Bhandari Vineet 
Published: August 2004

Objective.To report the current incidence and the need for surgery for retinopathy of prematurity (ROP) in neonates (22–36 weeks' gestational age [GA], July 1, 1989 through June 30, 1997).Study Design.Retrospective analyses using computerized perinatal database kept on all admissions, a review of patient charts, and eye examination log books.Setting.Level 3 regional referral NICU.Patients.A total of 2528 infants &lt;37 weeks' GA were admitted during this time. Of these infants, 950 met the criteria for eye examination beginning at 4 to 6 weeks of age and repeated every 2 weeks until complete vascularization of the retina or death or discharge.Results.The incidence of ROP was (202/950) 21.3% for any stage and 4.6% (44/950) for stage 3 ROP or greater. No ROP was noted in infants born at &gt;32 weeks' GA. No infant born at &gt;28 weeks needed retinal surgery. Using birth weight (BW) criteria, stage 3 ROP was not noted in infants with BWs &gt;1500 g; retinal surgery was not needed in infants with BWs &gt;1000 g. A number of perinatal factors were associated with ROP on univariate analysis. However, using multiple logistic regression analyses of these factors, only GA and days on supplemental oxygen therapy were associated significantly with the development of ROP. Despite increased survival of extremely low BW infants, we found a considerable reduction in incidence and severity of ROP compared with reports from an earlier chronological period. However, infants &lt;28 weeks' GA or with BWs &lt;1000 g were still at considerable risk for retinal surgical treatment for ROP.Conclusion.We conclude that the incidence and severity of ROP have decreased significantly in the present era of surfactant therapy.
Television-viewing Habits and Sleep Disturbance in School Children
Authors: Owens Judith , Maxim Rolanda , McGuinn Melissa , Nobile Chantelle , Msall Michael , Alario Anthony 
Published: August 2004

Objective.To investigate the relationship between specific television-viewing habits and both sleep habits and sleep disturbances in school children.Methods.The parents of 495 children in grades kindergarten through fourth grade in three public elementary schools completed two retrospective survey questionnaires, one assessing their children's sleep behaviors and the other examining television-viewing habits of both the child and the family. Sleep domains assessed included bedtime resistance, sleep onset delay, sleep duration, anxiety around sleep, parasomnias, night wakings, and daytime sleepiness. Teachers from all three schools also completed daytime sleepiness questionnaires (N = 402) for the sample.Results.Most of the television-viewing practices examined in this study were associated with at least one type of sleep disturbance. Despite overall close monitoring of television-viewing habits, one quarter of the parents reported the presence of a television set in the child's bedroom. The television-viewing habits associated most significantly with sleep disturbance were increased daily television viewing amounts and increased television viewing at bedtime, especially in the context of having a television set in the child's bedroom. The sleep domains that appeared to be affected most consistently by television were bedtime resistance, sleep onset delay, and anxiety around sleep, followed by shortened sleep duration. The parent's threshold for defining “problem sleep behavior” in their child was also important in determining the significance of the association between sleep disturbance and television-viewing habits.Conclusion.Health care practitioners should be aware of the potential negative impact of television viewing at bedtime. Parents should be questioned about their children's television-viewing habits as part of general screening for sleep disturbances and as part of anticipatory guidance in regards to healthy sleep habits in children. In particular, the presence of a television set in the child's bedroom may be a relatively underrecognized, but important, contributor to sleep problems in school children.