(IDSA) published an evidence-based guideline for the treatment of uncomplicated communityacquired pneumonia (CAP) in children, recommending aminopenicillins as the first-line therapy. Poor guideline compliance with 10%-50% of patients admitted to the hospital receiving narrow-spectrum antibiotics has been reported. A new clinical practice guideline (CPG) was implemented in our emergency department (ED) for uncomplicated CAP. The aim of this study was to examine baseline knowledge and ED provider prescribing patterns pre-and post-CPG implementation. METHODS: Prior to CPG-implementation, an anonymous case-based survey was distributed to evaluate knowledge of the current PIDS/IDSA guideline. A retrospective chart review of patients treated in the ED for CAP from January 2015 to February 2017 was performed to assess prescribing patterns for intravenous (IV) antibiotics in the ED at Children's National Health System pre-and post-CPG implementation. RESULTS: ED providers were aware of the PIDS/IDSA guideline recommendations, with 86.4% of survey responders selecting ampicillin as the initial antibiotic of choice. However, only 41.2% of patients admitted to the hospital with uncomplicated CAP pre-CPG received ampicillin (P<0.01). There was no statistically signifi cant increase in ampicillin prescribing post-CPG (P=0.40). CONCLUSIONS: Providers in the ED are aware of the PIDS/IDSA guideline regarding the first-line therapy for uncomplicated CAP; however, this knowledge does not translate into clinical practice. Implementation of a CPG in isolation did not significantly change prescribing patterns for uncomplicated CAP.

ObjectivesThe objective of this study was to compare the ultrasound‐measured inferior vena cava distensibility index (IVCdi), inferior vena cava distensibility variability (IVCdv), and inferior vena cava–to–aorta ratio (IVC/Ao) to other common methods to assess fluid status in mechanically ventilated pediatric critically ill patients. These methods include central venous pressure (CVP), percent fluid overload by weight (%FOw), and percent fluid overload by volume (%FOv).MethodsThis was a prospective observational study of a convenience sample of 50 mechanically ventilated pediatric patients. Ultrasound measurements of the inferior vena cava and aorta were obtained, and the IVCdi, IVCdv, and IVC/Ao were calculated and compared to CVP, %FOw, and %FOv.ResultsThe median %FOw was 5%, and the median %FOv was 10%. The mean CVP ± SD was 8.6 ± 4 mm Hg. The CVP had no significant correlation with %FOw or %FOv. There was no significant correlation of the IVCdi with CVP (r = –0.145; P = .325) or %FOv (r = 0.119; P = .420); however, the IVCdi had a significant correlation with %FOw (P = .012). There was also no significant relationship of the IVCdv with CVP (r = –0.135; P = .36) or %FOv (r = 0.128; P = .385); however, there was a significant correlation between the IVCdv and %FOw (P = .012). There was no relationship between the IVC/Ao and any other measures of fluid status.ConclusionsIn this cohort of mechanically ventilated pediatric intensive care unit patients, many commonly used markers of fluid status showed weak correlations with each other. The IVCdi and IVCdv significantly correlated with %FOw and may have potential as markers for fluid overload in this patient population.

Outpatient screening for social determinants of health (SDH) improves patient access to resources. However, no studies have examined if and how inpatient pediatric providers perform SDH screening. We aimed to identify inpatient pediatric provider screening practices for SDH, barriers to screening, and the acceptability of screening for hospitalized patients. METHODS: We conducted a multicenter descriptive study at 4 children's hospitals surveying inpatient hospitalists and nurses on the general wards about their SDH screening practices. A survey instrument was developed on the basis of literature pertaining to SDH, content expert review, cognitive interviews, and survey piloting. Descriptive statistics and logistic regression analyses are reported. RESULTS: Results from 146 hospitalists and 227 nurses were analyzed (58% and 26% response rate, respectively). Twenty-nine percent of hospitalists and 41% of nurses reported screening for $1 SDH frequently or with every hospitalized patient. Only 26% of hospitalists reported consistently communicating SDH needs with primary care providers. Most respondents (97% of hospitalists and 65% of nurses) reported they do not use a specific screening tool, and only 34% of hospitalists and 32% of nurses reported feeling competent screening for SDH. Lack of time, resources, and a standardized inpatient screening tool were reported as barriers to screening. CONCLUSIONS: Hospitalization provides an opportunity for SDH screening and connecting patients to resources; however, a minority of pediatric providers currently report screening. Professional development activities training inpatient providers in SDH screening, using a screening instrument, and communicating identified needs to primary care providers may improve the effectiveness of SDH screening in the hospital.

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